A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials
Abstract
Background Although several studies indicate that placebo response is large to antidepressant pharmacotherapy in major depressive disorder (MDD), no updated meta-analysis has quantified the magnitude of the placebo (sham) response to repetitive transcranial magnetic stimulation (rTMS) in MDD yet. Objective To conduct a systematic review and meta-analysis on this issue in randomized controlled trials (RCTs) involving participants with MDD; and to explore potential moderators. Methodology PubMed/MEDLINE, Embase, PsycINFO, and Web of Science electronic databases were searched from inception up to March 15, 2017 for RCTs that investigated the efficacy of any rTMS modality compared to sham intervention in participants with acute depressive episodes. Cochrane Risk of Bias Tool was used to estimate risks. We estimated the placebo effect size (Hedges's g, random-effects model) response using placebo groups baseline and endpoint depressive symptom scores. Meta-regressions have been employed to explore potential moderators of response. Results Sixty-one studies met eligibility criteria (N=1328; mean age, 47years; 57% females). Placebo response was large (g=0.8, 95% CI=0.65-0.95, p Conclusion Placebo response in rTMS depression trials was large and associated with depression improvement of the active treatment group. Such result suggests that excluding placebo responders with a run-in phase may not confer advantage since response to 'active' rTMS may decrease as well. Moreover, placebo…
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Evidence suggests that the placebo response in TMS has been increasing over the past two decades.
“evidence suggests that the placebo response in TMS has been increasing over the past two decades (Razza et al., 2018; Xu et al., 2023)”
From A double-blind, randomized, sham-controlled clinical trial of cerebellar intermittent theta burst stimulation for bipolar disorder: Safety, tolerability, mood and cognitive effects (2025) · cites this paper as Razza et al., 2018
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- Authors
- Razza, L. B., Moffa, A. H., Moreno, M. L., Carvalho, A. F., Padberg, F., Fregni, F., & Brunoni, A. R.
- Affiliations
- Universidade de São Paulo (BR)
- Universidade Federal do Ceará (BR)
- Ludwig-Maximilians-Universität München (DE)
- Harvard University (US)
- Corresponding author
- Brunoni, André R.
- ORCID
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 81
- Pages
- 105-113
- ISSN
- 0278-5846 (ISSN-L)
- OpenAlex
- W2766133064
- Cited by
- 172
- References
- 93
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 23 · 2023: 20 · 2022: 26 · 2021: 23 · 2020: 10 · 2019: 22 · 2018: 8
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- placebo response, repetitive transcranial magnetic stimulation, major depressive disorder, sham stimulation, treatment-resistant depression, run-in phase, antidepressant efficacy
- MeSH terms
- Major Depressive Disorder, Humans, Placebo Effect, Randomized Controlled Trials as Topic, Transcranial Magnetic Stimulation
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