Efficacy and safety of repetitive transcranial magnetic stimulation for major depressive disorder in Chinese patients: A systematic review and meta-analysis.

BACKGROUND

Major depressive disorder (MDD) imposes a substantial burden in China, with many patients experiencing inadequate response to conventional therapies. Repetitive transcranial magnetic stimulation (rTMS) and its patterned variant, intermittent theta burst stimulation (iTBS), have shown promise, but comprehensive evidence in Chinese populations is limited. This systematic review and meta-analysis evaluated the efficacy and safety of rTMS protocols in Chinese adults with MDD.

METHODS

Systematic searches were conducted in 5 databases (PubMed, Cochrane, Embase, CNKI, and Web of Science) until February 2025. Randomized, double-blind, sham-controlled trials of transcranial magnetic stimulation (rTMS/iTBS) targeting dorsolateral prefrontal cortex in Chinese MDD patients (DSM-IV/V criteria) were included. Methodological quality was assessed using Cochrane tools. Data analysis used RevMan 5.3, Stata 15.0, and GRADEpro for result analysis.

RESULTS

Seven randomized clinical trials (430 participants) demonstrated significant reductions in Hamilton Depression Rating Scale scores with active stimulation versus sham (standardized mean difference = -1.35, 95% confidence interval [CI]: -1.92 to - 0.78, P < .00001). Active stimulation also significantly improved response rates (7 studies, odds ratio = 2.45, 95% CI: 1.58-3.78) and remission rates (5 studies, odds ratio = 2.68, 95% CI: 1.61-4.48). No significant increase in adverse events (including dizziness [3 studies], nausea [3 studies], and headache [7 studies]) was observed. The overall certainty of evidence for Hamilton Depression Rating Scale reduction was rated as low due to heterogeneity and risk-of-bias concerns.

CONCLUSION

Repetitive transcranial magnetic stimulation (including high-frequency rTMS and iTBS) is effective and safe for treating MDD in Chinese patients. These findings support its wider clinical application, although further large-scale, high-quality trials are warranted.