Repetitive Transcranial Magnetic Stimulation for Depression Due to Cerebrovascular Disease: A Systematic Review

This study aims to perform a systematic review evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving depression resulting from cerebrovascular disease including vascular depression (VD) and poststroke depression (PSD).

A literature search of multiple scientific databases was conducted for English studies published from January 1980 to June 2016. Studies were included if the sample consisted of 50% or more adult humans with VD or PSD and had 3 or more subjects, the intervention applied was rTMS, and depression was assessed pre- and post intervention using a formal outcome measure. Randomized controlled trials (RCTs) were assessed for methodological quality using the Physiotherapy Evidence Database (PEDro) tool. A level of evidence was assigned to each study according to the modified Sackett Scale.

Five studies met the inclusion criteria including 3 RCTs (level 1b; PEDro range: 6-8) and 2 uncontrolled pre-post studies (level 4). There were 186 participants with either PSD (n = 40) or VD (n = 146); the majority of the participants were female (52.7%) and had a mean age ranging from 51.9 to 67.9 years. There were no adverse effects reported by any of the studies. Using clinically accepted criteria for the response rate, all studies reported a benefit from rTMS for the treatment of depression. Three studies also demonstrated a benefit on remission rates as well.

rTMS was reported to be beneficial in treating depression among individuals with cerebrovascular disease over the short term. However, heterogeneous populations and variability in study design and protocol, as well as a limited number of studies to review, challenge the ability to form conclusions as to the effectiveness of rTMS.