Efficacy and Safety of Deep Transcranial Magnetic Stimulation Versus High-Frequency Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder: A Systematic Review

Deep transcranial magnetic stimulation (dTMS), an alternative technique to repetitive transcranial magnetic stimulation (rTMS), can generate suprathreshold fields in the lateral frontal regions up to 5–6 cm in depth, with stimulator output power exceeding 120% of the hand movement threshold. This systematic review aimed to evaluate and compare the safety and effectiveness of dTMS with that of high-frequency rTMS (HF-rTMS; ≥10 Hz) in individuals diagnosed with major depressive disorder (MDD).

Chinese and English databases were searched for randomized controlled trials (RCTs) comparing dTMS and HF-rTMS. The overall antidepressant response and remission rates were the co-primary outcomes.

Two RCTs (n = 203) investigating the efficacy and safety of dTMS (n = 100) versus HF-rTMS (n = 103) in adult patients with MDD met the inclusion criteria. The two included studies were of high quality, with a Jadad score of ≥ 3. Among the two RCTs, the overall antidepressant response rate was significantly higher in the dTMS (60.0%) than in the HF-rTMS group (41.7%). Only one RCT reported the antidepressant remission rates, demonstrating no significant difference between the two TMS groups. Compared to HF-rTMS, dTMS elicited more muscle twitching/spasms or jaw pain incidences. Other adverse events and discontinuation rates (dTMS group: 12% versus HF-rTMS group: 5%) were similar across both RCTs.

dTMS leads to a better antidepressant response than HF-rTMS, although both interventions have favorable safety profiles. However, more RCTs using rigorous methodologies are warranted.