Comparison of therapeutic efficacy in depression between repetitive TMS and deep TMS

Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique with promising potential in treating psychiatric and neurological disorders. By offering an alternative to surgery or medication, TMS could significantly enhance patient outcomes and quality of life, particularly for those with conditions resistant to traditional therapies. With ongoing research advancements, TMS may become a cornerstone of personalized medicine, enabling treatments tailored to individual brain patterns and needs. Although rTMS has FDA approval and dTMS has clearance for treating treatment-resistant depression (TRD), comparative studies between these techniques remain scarce. This systematic review aims to assess and compare the efficacy of rTMS and dTMS in TRD through the analysis of observational studies and clinical trials that directly compare these two treatments. Relevant literature was identified through searches in Web of Science, Scopus, Cochrane Library, PsycINFO, PubMed, and Open Gray, covering studies published in English from 2014 to 2024. Only three studies, including one observational study and two RCTs, met inclusion criteria, indicating similar efficacy and safety for both techniques. This review highlights that both rTMS and dTMS are effective and safe for treating TRD, with no significant differences in symptom remission. However, dTMS is significantly more expensive, making rTMS a more viable option in resource-limited settings. The review underscores the need for further multicenter and long-term studies to better clarify the cost-effectiveness of these treatments.