Table 2.

Meta-Analysis Results of Included Studies

	Outcome Measure	Included Studies	Total Included Patients, n (range)	Risk Ratio (95% CI)	I2 (%)	Findings
Adult
rTMS vs sham	Response	Avery et al,18 Bakim et al,54 Bares et al,56 Berman et al,20 Blumberger et al,16 Boutros et al,19 Chen et al,47 Fitzgerald et al,38,40 Garcia-Toro et al,44 George et al,21 Hernández-Ribas et al,45 Holtzheimer et al,60 Jorge et al,23,24 Kauffmann et al,25 Loo et al,41,42 Manes et al,28 Mantovani et al,29 McDonald et al,30 Mosimann et al,32 O’Reardon et al,36 Padberg et al,51 Paillère Martinot et al,58 Peng et al,48 Rossini et al,53 Stern et al,35 Su et al,49 Zheng et al50	rTMS: 685 (7–155) Sham: 650 (5–146)	2.35 (1.70–3.25)	36.1	rTMS is an effective treatment; patients undergoing rTMS are twice as likely to achieve either clinical response or remission than patients undergoing a sham procedure
	Remission	Avery et al,18 Bakim et al,54 Bares et al,56 Blumberger et al,16 Fitzgerald et al,39 George et al,21 Jorge et al,23,24 Kauffmann et al,25 Loo et al,41 Manes et al,28 Mantovani et al,29 McDonald et al,30 O’Reardon et al,36 Padberg et al,51 Rossini et al,53 Stern et al,35 Su et al49	rTMS: 536 (7–155) Sham: 501 (5–146)	2.24 (1.53–3.27)	1.1
High-frequency rTMS vs low-frequency rTMS	Response	Eche et al,62 Fitzgerald et al,38 Fitzgerald et al,63 Fitzgerald et al,64 Fitzgerald et al,65 Isenberg et al,66 Richieri et al,69 Rossini et al,70 Speer et al,34 Stern et al,35 Su et al4	High frequency: 226 (6–63) Low frequency: 239 (8–67)	1.19 (0.97–1.46)	0.0	The optimal frequency of rTMS is unclear; there is a trend toward high-frequency rTMS being more effective to achieve both clinical response and remission than low frequency rTMS; however, both 95% CIs cross 1.0, indicating that compared to low-frequency rTMS, high-frequency rTMS may be equivalent, more effective, or less effective
	Remission	Fitzgerald et al,39,63 Isenberg et al, 66 Speer et al,34 Stern et al,35 Su et al49	High frequency: 120 (10–63) Low frequency: 130 (8–67)	1.29 (0.75–2.22)	8.1
Unilateral rTMS vs bilateral rTMS	Response	Blumberger et al,16 Fitzgerald et al,40,61,71 Pallanti et al72	Unilateral: 232 (20–91) Bilateral: 298 (21–147)	1.15 (0.85–1.52)	45.8	The optimal location of treatment for rTMS is unclear;there is a trend toward bilateral rTMS being more effective to achieve both clinical response and remission than bilateral; however, both 95% CIs cross 1.0, indicating that compared to bilateral, unilateral rTMS may be equivalent, more effective, or less effective
	Remission	Blumberger et al,16 Fitzgerald et al,61 Fitzgerald et al71	Unilateral: 188 (26–91) Bilateral: 256 (21–147)	1.18 (0.71–1.96)	53.6
Low-intensity rTMS vs high-intensity rTMS	Response	Bakim et al,54 Padberg et al,51 Rossini et al53	Low intensity: 40 (10–18) High intensity: 39 (10–18)	1.15 (0.54–2.41)	57.3	The optimal intensity of rTMS is unclear; there is a trend toward high-intensity rTMS being more effective to achieve both clinical response and remission than low intensity; however, both 95% CIs cross 1.0, indicating that compared to low intensity, high-intensity rTMS may be equivalent, more effective, or less effective
	Remission	Bakim et al,54 Padberg et al,51 Rossini et al53	Low intensity: 40 (10–18) High intensity: 39 (10–18)	1.72 (0.89–3.33)	0.0
rTMS vs other rTMS protocols	Narrative summary	Image guidance: Fitzgerald et al,73 Garcia-Toro et al,44 Paillère Martinot58 Right vs left dorsolateral prefrontal cortex: Pascual-Leone et al,46 Triggs et al,37 Scheduling: Galletly et al,74 Turnier-Shea et al75 Electroencephalography timed: Price et al76 Combination protocols: Conca et al,77 Fitzgerald et al,78 Levkovitz et al,79 McDonald et al,30 Rybak et al80		NA	NA	Experimentation to identify the optimal rTMS protocol is ongoing with research exploring the impact of image-guided, scheduling, and combination therapy
rTMS vs ECT	Response	Grunhaus et al,81 Janicak et al,82 Rosa et al86	rTMS: 41 (8–20 ECT: 39 (8–20)	1.09 (0.79–1.48)	0.0	The effectiveness of rTMS compared to ECT is unclear; there is a trend toward rTMS being more effective to achieve clinical response but less effective to achieve remission; however, both 95% CIs cross 1.0, indicating that compared to ECT, rTMS may be equivalent, more effective, or less effective
	Remission	Grunhaus et al,81 Pridmore et al,84 Rosa et al86	rTMS: 44 (8–20 ECT: 44 (8–20)	0.97 (0.65–1.45)	0.0
Youth
rTMS		Bloch et al,87 Croarkin et al,88 Mayer et al89	rTMS: 24 (7–9)	NA	NA	The included studies suggest that rTMS may be an effective intervention for treatment-resistant youth and young adults; however, the evidence is too weak to draw conclusions

Abbreviations: NA = not applicable, rTMS = repetitive transcranial magnetic stimulation.