AUTHOR=Sun Chen-Hui , Mai Jian-Xin , Shi Zhan-Ming , Zheng Wei , Jiang Wen-Long , Li Ze-Zhi , Huang Xing-Bing , Yang Xin-Hu , Zheng Wei 

TITLE=Adjunctive repetitive transcranial magnetic stimulation for adolescents with first-episode major depressive disorder: a meta-analysis

JOURNAL=Frontiers in Psychiatry

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1200738

DOI=10.3389/fpsyt.2023.1200738

ISSN=1664-0640

ABSTRACT=<sec id="sec1"><title>Objective</title><p>This meta-analysis of randomized clinical trials (RCTs) was conducted to explore the therapeutic effects, tolerability and safety of repetitive transcranial magnetic stimulation (rTMS) as an adjunct treatment in adolescents with first-episode major depressive disorder (FE-MDD).</p></sec><sec id="sec2"><title>Methods</title><p>RCTs examining the efficacy, tolerability and safety of adjunctive rTMS for adolescents with FE-MDD were included. Data were extracted by three independent authors and synthesized using RevMan 5.3 software with a random effects model.</p></sec><sec id="sec3"><title>Results</title><p>A total of six RCTs involving 562 adolescents with FE-MDD were included. Adjunctive rTMS was superior in improving depressive symptoms over the control group [standardized mean difference (SMD) = −1.50, 95% confidence interval (CI): −2.16, −0.84; <italic>I</italic><sup>2</sup> = 89%, <italic>p</italic> &lt; 0.00001] in adolescents with FE-MDD. A sensitivity analysis and two subgroup analyses also confirmed the significant findings. Adolescents with FE-MDD treated with rTMS had significantly greater response [risk ratio (RR) = 1.35, 95% CI: 1.04, 1.76; <italic>I</italic><sup>2</sup> = 56%, <italic>p</italic> = 0.03] and remission (RR = 1.35, 95% CI: 1.03, 1.77; <italic>I</italic><sup>2</sup> = 0%, <italic>p</italic> = 0.03) over the control group. All-cause discontinuations were similar between the two groups (RR = 0.79, 95% CI: 0.32, 1.93; <italic>I</italic><sup>2</sup> = 0%, <italic>p</italic> = 0.60). No significant differences were found regarding adverse events, including headache, loss of appetite, dizziness and nausea (<italic>p</italic> = 0.14–0.82). Four out of six RCTs (66.7%), showed that adjunctive rTMS was more efficacious over the control group in improving neurocognitive function (all <italic>p</italic> &lt; 0.05).</p></sec><sec id="sec4"><title>Conclusion</title><p>Adjunctive rTMS appears to be a beneficial strategy in improving depressive symptoms and neurocognitive function in adolescents with FE-MDD. Higher quality RCTs with larger sample sizes and longer follow-up periods are warranted in the future.</p></sec>