Domain-Specific Efficacy of Accelerated Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders: A Systematic Review and Meta-Analysis.
Hangbin Zhang, Jacob Green, Shraddha Dwivedi et al.
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In 30 seconds
This preregistered systematic review and random-effects meta-analysis assessed accelerated repetitive transcranial magnetic stimulation (arTMS; at least two sessions daily) versus sham in randomized trials across psychiatric symptom domains. The review included 44 trials with 1,671 participants. Compared with sham, arTMS showed a moderate effect on depressive symptoms (Hedges’ g = 0.61; 95% CI, 0.38 to 0.85), with improvements also reported in anxiety, obsessive-compulsive symptoms, working memory, and declarative memory. Stimulation parameters and participant characteristics moderated outcomes in some domains; reported adverse events were mild and transient.
Key findings
- For depressive symptoms, arTMS versus sham had Hedges’ g = 0.61 (95% CI, 0.38 to 0.85).
- Improvements versus sham were reported for anxiety (g = 0.43; 95% CI, 0.05 to 0.81) and obsessive-compulsive symptoms (g = 0.45; 95% CI, 0.02 to 0.88).
- Working memory improved (g = 0.45; 95% CI, 0.11 to 0.79), as did declarative memory (g = 0.30; 95% CI, 0.02 to 0.58).
- Session frequency, intersession interval, cumulative pulse dose, age, and sex moderated outcomes in specific domains; adverse events were mild and transient.
Why it matters
The findings suggest that arTMS may affect several symptom and cognitive domains, rather than a single diagnostic category, and that outcomes may vary with stimulation parameters and participant characteristics. This supports evaluating domain-specific outcomes and treatment moderators in future trials. The reported mild, transient adverse events are relevant when considering the intervention’s safety profile, while the evidence remains based on comparisons with sham in randomized trials.
What to keep in mind
The review reports outcomes across 20 symptom domains, with moderator effects specific to some domains; the abstract does not provide details on follow-up duration or the certainty of evidence for individual outcomes.