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Advances in repetitive transcranial magnetic stimulation for posttraumatic stress disorder: a systematic review

Belsher, Bradley, Beech, Erin, Reddy, Madhavi, Smolenski, Derek, Rauch, Sheila, Kelber, Marija, Issa, Fuad, Lewis, Catrin and Bisson, Jonathan 2021. Advances in repetitive transcranial magnetic stimulation for posttraumatic stress disorder: a systematic review. Journal of Psychiatric Research 138 , pp. 598-606. 10.1016/j.jpsychires.2021.05.011
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Repetitive transcranial magnetic stimulation (rTMS) as a treatment for posttraumatic stress disorder (PTSD) has gained interest over the past two decades. However, it has yet to be recommended in major treatment guidelines. We conducted a systematic review of randomized controlled trials to examine the efficacy of rTMS for PTSD. Thirteen studies with 549 participants were included in this review. We compared the effects of (1) rTMS versus sham, and (2) high-frequency (HF) versus low-frequency (LF) rTMS, on posttreatment PTSD scores and other secondary outcomes. We calculated the standardized mean differences (SMD) to determine the direction of effects, and unstandardized mean differences to estimate the magnitude of efficacy. At post-treatment, rTMS was superior to sham comparison in reducing PTSD (SMD = −1.13, 95% CI: −2.10 to −0.15) and depression severity (SMD = −0.83, 95% CI: −1.30 to −0.36). The quality of evidence, however, was rated very low due to small samples sizes, treatment heterogeneity, inconsistent results, and an imprecise pooled effect. HF rTMS was associated with slightly improved, albeit imprecise, outcomes compared to LF rTMS on PTSD (SMD = −0.19, 95% CI: −1.39 to 1.00) and depression (SMD = −1.09, 95% CI: −1.65 to −0.52) severity. Further research is required to advance the evidence on this treatment.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: Elsevier
ISSN: 0022-3956
Date of First Compliant Deposit: 5 May 2021
Date of Acceptance: 1 May 2021
Last Modified: 10 Jun 2021 12:18

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