Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls

Table 4 Summary of meta-analyses comparing transcranial magnetic stimulation and electroconvulsive therapy in depression

Meta-analysis	No. of studies/sample size	Mean age range	Summary of effect
Berlim et al[47] 2013	7/294	31.0-63.6	NNT = 6 favouring ECT for short-term response; at baseline, ECT samples had shorter illness duration and higher HAMD scores than rTMS samples. Age has no moderating effect on the differences
Ren et al[46] 2014	9/425	31.0-63.6	NNT = 7 for response; 6 for remission favouring ECT; No significant group difference when continuous change in HAMD scores is considered as outcome; In the absence of psychosis, rTMS as efficacious as ECT; Cognitive domains are better preserved after rTMS than ECT
Micallef-Trigona[49] 2014	9/384	34.0-63.6	Hedges’g = 1.28 for rTMS and 2.15 for ECT. rTMS produces a mean reduction of 9.3 points; ECT produces a mean reduction of 15.42 points on the HDRS
Xie et al[48] 2013	9/395	31.0-63.6	OR = 0.55 for response and 0.49 for remission in favour of ECT; rTMS is better tolerated than ECT (OR = 0.70); rTMS > 1200 stimuli/d is as efficacious as ECT

NNT: Number needed to treat; TMS: Transcranial magnetic stimulation; ECT: Electroconvulsive therapy; HAMD: Hamilton Depression Rating Scale.