Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomized controlled trials

Chen, Jian-jun; Liu, Zhao; Zhu, Dan; Li, Qi; Zhang, Hongzhi; Huang, Hua; Wei, Youdong; Mu, Jun; Yang, Deyu; Xie, Peng

doi:10.1016/j.psychres.2014.05.010

Cited by 71Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionElectroconvulsive Therapy Studies

Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomized controlled trials

Chen, Jian-jun, Liu, Zhao, Zhu, Dan, Li, Qi, Zhang, Hongzhi, Huang, Hua, Wei, Youdong, Mu, Jun +2 more·2014·Psychiatry Research

DOI 10.1016/j.psychres.2014.05.010

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Abstract

Previous studies have demonstrated inconsistent findings regarding the efficacy of bilateral vs. unilateral repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD). Therefore, this meta-analysis was conducted to compare the efficacy of these two rTMS modalities. Data were obtained from seven randomized controlled trials (RCTs) consisting of 509 subjects. Bilateral and unilateral rTMS displayed comparable efficacy in treating MDD with a pooled odds ratios of 1.06 (95% confidence interval (CI)=0.58-1.91) for response rates and 1.05 (95% CI=0.52-2.11) for remission rates. Subgroup analysis found that bilateral rTMS was equally effective in comparison with both left and right unilateral rTMS. No significant differences in drop-out rates were found. No publication bias was detected. In conclusion, the pooled examination demonstrated that bilateral rTMS displays comparable anti-depressant efficacy and acceptability to unilateral rTMS in treating MDD. These findings suggest that simultaneous rTMS of the right and left dorsolateral prefrontal cortices in MDD patients does not provide marginal benefits in terms of efficacy or acceptability. As the number of RCTs included here was limited, further large-scale multi-center RCTs are required to validate our conclusions.

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Major depression is characterised by relative hypoactivity of the left and hyperactivity of the right dorsolateral prefrontal cortex.
“major depression is characterised by relative hypoactivity of the left and hyperactivity of the right dorsolateral prefrontal cortex (DlPFc)”
From Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury (2026) · cites this paper as Chen et al. 2014
Bilateral rTMS has shown efficacy and acceptability at least comparable to unilateral stimulation for depression.
“bilateral rtMs has shown efficacy and acceptability at least comparable to unilateral stimulation for depression”
From Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury (2026) · cites this paper as Chen et al. 2014

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A Randomized Double Blind Sham-controlled Comparison of Bilateral and Unilateral Repetitive Transcranial Magnetic Stimulation for Treatment-resistant Major Depression
Blumberger, D. (2011) · TSpace (University of Toronto)

Authors: Chen, J.-J., Liu, Z., Zhu, D., Li, Q., Zhang, H., Huang, H., Wei, Y., Mu, J., Yang, D., & Xie, P.
Affiliations: The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
Chongqing Medical University (CN)
Corresponding author: Xie, Peng
ORCID: Zhu, Dan
Li, Qi
Huang, Hua
Wei, Youdong
Mu, Jun
Yang, Deyu
Xie, Peng
Venue: Psychiatry Research
Publisher: Elsevier BV
Published: 2014-09
Volume: 219
Issue: 1
Pages: 51-57
ISSN: 0165-1781 (ISSN-L)
DOI: 10.1016/j.psychres.2014.05.010
OpenAlex: W2171327262
Cited by: 71
References: 53
Citations by year: 2026: 4 · 2025: 7 · 2024: 6 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 13 · 2015: 4 · 2014: 1
FWCI: 0.65
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Psychiatry Research (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords: repetitive transcranial magnetic stimulation, major depressive disorder, antidepressant efficacy, response rate, remission rate, treatment acceptability, dorsolateral prefrontal cortex, treatment discontinuation
MeSH terms: Depressive Disorder, Major, Major Depressive Disorder, Humans, Male, Randomized Controlled Trials as Topic, Treatment Outcome, Transcranial Magnetic Stimulation

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Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomized controlled trials

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