The efficacy of trans-cranial magnetic stimulation for relieving post-stroke depression: A meta-analysis

Abstract

Objective To assess the effectiveness of repeated trans-cranial magnetic stimulation (rTMS) in relieving post-stroke depression (PSD). Methods PubMed, Embase, the Cochrane library, Web of Science, CNKI, WANFANG, and VIP were searched for reports of randomized, controlled trials of rTMS treatment of PSD published before June 2015. Crude standardized mean differences (SMDs) and odds ratios with 95% confidence intervals (CIs) were calculated for depression intensity and effectiveness rate after treatment using random or fixed effects models. Results Twenty-four studies involving 856 rTMS-treated patients and 802 control patients were included in the meta-analysis. The results showed that compared with the control group, PSD patients showed significant reductions in depression after rTMS treatment (SMD=-1.36; 95% CI -1.6 to -1.12; P≤0.05). The total effectiveness rate in the treated group was 85% with a reduction in NIHSS score (SMD=-0.82; 95% CI -1.2 to -0.44; P≤0.05). Subgroup analysis showed that neither the frequency of rTMS stimulation, the site stimulated, nor time after stroke had a significant influence on the effectiveness of rTMS. Additionally, a few studies reported adverse reactions after rTMS. Conclusion rTMS appears to be a safe and effective therapy for PSD. Further well-controlled trials may elucidate the mechanism underlying the placebo effects of the sham rTMS observed among PSD patients. Key words: Transcranial magnetic stimulation; Stroke; Depression