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Updated: Jun 2, 2026
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
Repetitive Transcranial Magnetic Stimulation (rTMS) for Adolescent Depression: A Systematic Review and Meta-Analysis
Lidija Rakic1, Floris Tas1,2,3, Miao Chen1
1GGz Centraal, Amersfoort, the Netherlands.
Introduction:
Major depressive disorder (MDD) affects 11%-19% of adolescents globally. Early treatment is vital, but the risk of relapse is high, with 46% relapse within 5 years, which threatens a chronic course. Hence, better solutions are needed. Repetitive transcranial magnetic stimulation (rTMS) is effective in adults, but its use in adolescents is limited. While studies-including trials and meta-analyses-exist, their generalizability is unclear. This review evaluates rTMS's efficacy and safety for adolescent MDD.
Methods:
Following PRISMA guidelines, a comprehensive literature review was conducted using English-language databases Embase, PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews. We included studies published up to February 2025. Data were pooled to calculate standardized mean change (SMC), proportions, log odds ratios, and their respective 95% confidence intervals (CI), measuring effectiveness, response rate, and suicidality. We systematically described adverse effects.
Results:
We identified 687 studies, 42 underwent full-text assessment, and 19 were included. The within-intervention group pooled SMC between pre-post scores of depression severity was -2.15 (95% CI [-2.58, -1.73]), indicating a strong effect but with high heterogeneity (I 2 = 87.13%). For RCT-only studies, the pooled SMC was -0.90 (95% CI [-1.90, 0.11]), showing a smaller effect. The pooled response rate was 54% (95% CI [42%; 66%]) with similarly high heterogeneity (I 2 = 82.25%). A large reduction in suicidal ideation was observed (pooled SMC = -2.78, 95% CI [-5.98, 0.42]), albeit this was based on a limited number of studies (n = 3) and the SMC was not statistically significant. Mild and transient adverse effects were reported. The majority of studies were rated as having a high risk of bias.
Conclusion:
Our findings demonstrated that rTMS is effective, safe, and well-tolerated by adolescents with MDD. However, high heterogeneity of methods, bias, and inclusion of uncontrolled trials demand more rigorous trials, whereby adaptive designs could potentially increase the empirical availability.
