Repetitive transcranial magnetic stimulation for treating post-stroke depression: a systematic review and network meta-analysis

Objective To systematically evaluate the effects of different modes of repetitive transcranial magnetic stimulation (rTMS) on depression in post-stroke depression (PSD) patients using the network meta-analysis method. Methods PubMed, Web of Science, Cochrane Library, Embase, Wanfang Data, CNKI, VIP, and CBM were searched for randomized controlled trials on rTMS for PSD from the time the database was constructed until April 20th, 2024. Two researchers independently conducted screenings to extract the relevant literature. The meta-analysis was performed using RevMan 5.4.1 software. Network meta-analysis of depression scores was performed using Stata 17.0 software and R 4.4.1 software. Results Twelve studies involving four different rTMS modalities were included. The results of the meta-analysis revealed that rTMS significantly improved depression (SMD = -1.47, 95% CI [-1.97, -0.97]) and activity of daily living (ADL) (SMD = 0.78, 95% CI [0.52, 1.04]) in patients with PSD. The follow-up results revealed that rTMS significantly improved depression in the long term (SMD = -1.74, 95% CI [-2.32, -1.17]). The results of the network meta-analysis revealed that dual-rTMS (SMD = -2.33, 95% CI [-3.16, -1.50]), HF-rTMS (SMD = -1.62, 95% CI [-2.11, -1.13]), iTBS (SMD = -1.57, 95% CI [-2.56, -0.57]), and LF-rTMS (SMD = -0.80, 95% CI [-1.36, -0.23]) significantly improved depression compared with sham stimulation. The SUCRA values in descending order were dual-rTMS (95.9%) > HF-rTMS (65.0%) > iTBS (61.9%) > LF-rTMS (27.1%). Conclusions Twenty minutes of 4-week dual-rTMS on the DLPFC of PSD patients may produce better therapeutic effects. High-quality, large-sample, standardized RCT trials can be conducted to further test the scientific validity of the findings.