Comparing efficacies of different transcranial magnetic stimulation targeting methods for depression: A meta-analysis.

Background: Transcranial magnetic stimulation over the left dorsolateral prefrontal cortex is widely used to treat patients with major depressive disorder. The left dorsolateral prefrontal cortex is located using the "5 cm", F3, or neuro-navigational methods. However, whether treatment efficacy differs according to the method used remains unclear.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Randomized controlled trials that compared the efficacy of sham with active transcranial magnetic stimulation using at least one of the three targeting methods or compared different targeting methods in active transcranial magnetic stimulation were selected. The data were independently extracted by two authors and discrepancies were resolved by a third author. The primary outcome was the change in the severity of depressive symptoms. The secondary outcomes were acceptability (drop-out rate) and tolerability (incidence of adverse events).

Results: Network meta-analysis of 63 randomized controlled trials involving 3080 participants showed that active transcranial magnetic stimulation using the neuro-navigational (standardized mean difference = 1.19, 95 % confidence interval = 0.55-1.84) and "5 cm" methods (standardized mean difference = 1.13, 95 % confidence interval = 0.79-1.47) had greater anti-depressant efficacy than sham transcranial magnetic stimulation. The neuro-navigational method had the highest surface under the cumulative ranking curve score (79.3), followed by the "5 cm" method (73.9) and the F3 method (40.1). Neuro-navigation also exhibited the lowest drop-out rate and the highest incidence of adverse events.

Conclusions: Transcranial magnetic stimulation using neuro-navigation was associated with good efficacy, high acceptability, and low tolerability compared with sham transcranial magnetic stimulation.