Altered response to repetitive transcranial magnetic stimulation in patients with chronic primary insomnia

BackgroundWe aimed at evaluating the amplitude changes of the motor evoked potentials (MEPs) induced by of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) in10 patients with primary insomnia (PI) and in 10 age-matched healthy controls.MethodsMedian peak-to-peak MEP amplitudes were assessed in all subjects at three times: at baseline (T₀), after the first train of a single rTMS session (T₁), and after the whole rTMS procedure (T₂). This consists of 20 trains of 1 Hz stimulation with 50 stimuli per train and an intertrain interval of 30 s.ResultsResting motor threshold (RMT) and MEPs amplitude did not differ between the two groups at T₀. A reduction of MEP size was observed at both T₁ and T₂ in all subjects, but this was significantly less pronounced in patients than in control subjects.ConclusionsThe lack of MEP inhibition reflects an altered response to LF rTMS in patients with PI. These rTMS findings are indicative of an altered cortical plasticity in inhibitory circuits within M1 in PI. Subjects with PI exhibited an impairment of the LTD-like mechanisms induced by inhibitory rTMS, thus providing further support to the involvement of GABA neurotransmission in the pathophysiology of PI.     

The cerebral hemodynamics of repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of affective disorders. However, only little is known about hemodynamic physiological and safety aspects of this method. We studied the cerebral hemodynamics as measured by transcranial Doppler sonography in 20 healthy subjects during different rTMS procedures. Mean cerebral blood flow velocity (CBFBV), pulsatility index (PI), and oxygen consumption were recorded continuously and averaged directly after the rTMS procedure. RTMS did not influence blood pressure, pulse rate, or blood oxygenation. There was a maximal increase of CBFV in the middle cerebal artery (MCA) of 3.6% and 5.6% during 10 Hz and 20 Hz stimulation, respectively. This increase was only seen on the stimulated left hemisphere. The PI remained unchanged during the whole procedure. It is likely that the increase of CBFV is due to dilatation of the small resistance vessels rather than due to vasoconstriction of the MCA. In terms of cerebral hemodynamics, rTMS is a safe and well-tolerated technique with a lower increase of CBFV than that seen in electroconvulsive therapy. Received: 22 March 2000 / Accepted: 4 July 2000     

劳拉西泮联合低频重复经颅磁刺激对慢性失眠障碍的效果

目的探讨劳拉西泮联合低频重复经颅磁刺激(rTMS)对慢性失眠障碍的临床疗效,为慢性失眠障碍的治疗提供参考。方法纳入符合《中国失眠障碍诊断和治疗指南》慢性失眠障碍诊断标准的患者120例,按照随机数字表法分为劳拉西泮联合低频rTMS治疗组(研究组)与劳拉西泮联合伪低频rTMS治疗组(对照组)各60例。于治疗前和治疗第4周末进行多导睡眠监测(PSG),于治疗前和治疗第1、2、4周末进行匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定。结果①治疗第4周末,研究组PSQI评分低于对照组(t=-3. 506,P=0. 001),研究组睡眠质量疗效的显效率和有效率均高于对照组(χ~2=4. 658、5. 926,P均0. 05);研究组实际睡眠总时间、睡眠效率均高于对照组(t=2. 333～3. 784,P均0. 05),睡眠潜伏期、觉醒时间、觉醒次数、快速眼球运动睡眠潜伏期均低于对照组(t=-2. 903～-2. 214,P均0. 05)。②治疗第4周末,研究组HAMA评分低于对照组(t=-2. 072,P0. 05);治疗第1、2、4周末,研究组HAMD-17评分均低于对照组(t=-2. 190～-1. 701,P均0. 05)。结论劳拉西泮联合低频rTMS可能有助于改善慢性失眠障碍患者的睡眠质量,并缓解其抑郁、焦虑等负性情绪。     

重复经颅磁刺激治疗伴躯体疼痛抑郁症患者的疗效观察

目的探讨重复经颅磁刺激（rTMS）治疗伴有躯体疼痛的抑郁症患者的临床疗效和安全性。方法将60例伴有躯体疼痛的抑郁症患者随机分为两组,各30例,均给予度洛西汀口服8周,研究组同时联用rTMS,对照组则予假性rTMS刺激4周,观察8周。于治疗前及治疗后第1,2,3,4,8周应用汉密尔顿抑郁量表（HAMD）、医学结局研究用疼痛量表（MOSPM）和治疗中出现的不良反应量表（TESS）评定两组的治疗效果和安全性。结果治疗结束后两组的MOSPM和HAMD评分均较治疗前显著下降（P〈0．05）;治疗第1,2,3,4周,研究组的MOSPM评分低于对照组,差异有统计学意义（P〈0．05）;治疗第2,3,4周,研究组的HAMD评分低于对照组而显效率高于对照组,差异有统计学意义（P〈0．05）;治疗第8周,两组患者的MOSPM和HAMD评分及显效率差异均无统计学意义（P〉0．05）,治疗期间无严重不良反应发生。结论rTMS能有效治疗伴躯体疼痛的抑郁症,迅速缓解疼痛改善抑郁症状,早期疗效优于单一度洛西汀治疗,且安全性高。     

重复经颅磁刺激对抑郁症患者磁共振波谱和疗效的影响

目的 探讨重复经颅磁刺激(rTMS)治疗抑郁症患者的疗效及可能机制. 方法 选择自2012年8月至2014年7月在全军精神疾病防治研究所住院的抑郁症患者70例,所有患者均符合美国精神障碍诊断与统计手册第4版诊断标准.按照随机数字表法将患者随机分为研究组(n=36)和对照组(n=34),2组患者均接受盐酸文拉法辛缓释片(75 mg/片)治疗.研究组同时联合10Hz rTMS作用于左侧背外侧前额叶(DLPFC)治疗4周,对照组给予rTMS伪刺激.治疗前后采用多体素磁共振质子波谱(1H-MRS)检测患者前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr)含量.采用汉密尔顿抑郁量表(HAMD)于治疗前、治疗4周评估临床症状和疗效. 结果 (1)研究组治疗前左侧前额叶、左侧丘脑NAA/Cr值分别为1.51±0.34、1.36±0.29,治疗后分别升高至1.71±0.42、1.54±0.34,差异有统计学意义(P＜0.05).对照组双侧前额叶、双侧丘脑的NAA/Cr值、Cho/Cr值治疗前后差异均无统计学意义(P＞0.05).(2)研究组、对照组治疗前HAMD评分分别为32.3±8.8、31.8±8.5,治疗后降低为12.3±4.7、15.2±5.0,差异均有统计学意义(P＜0.05).研究组治疗前后的HAMD评分差值大于对照组,差异有统计学意义(P＜0.05).(3)治疗后,研究组显效率为80.6％(29/36)、治愈率为27.8％(10/36),对照组显效率为50.0％(17/34)、治愈率为5.9％(2/34),2组间显效率和治愈率的差异均有统计学意义(P＜0.05).(4)研究组盐酸文拉法辛缓释片平均治疗剂量为(136.6±28.4)mg/d、最大剂量为(175.0±35.6)mg/d;对照组平均治疗剂量为(162.4±32.2)mg/d、最大剂量为(216.2±40.3)mg/d;组间差异均有统计学意义(P＜0.05). 结论 10 Hz rTMS联合盐酸文拉法辛缓释片可以调节抑郁症患者前额叶和丘脑的神经生化代谢,进而改善抑郁症状,降低抗抑郁药物使用剂量.     

重复经颅磁刺激治疗孤独谱系障碍的研究进展

重复经颅磁刺激(rTMS)是一种利用时变磁场作用于大脑皮质产生感应电流,进而改变大脑皮质神经细胞的动作电位,影响大脑代谢状况及神经元活动的生物技术.目前广泛应用于神经精神疾病的临床康复当中.孤独谱系障碍(ASD)是一种以持久的社会沟通和交往能力损害为主要特征,伴有重复和刻板行为的广泛性发育障碍,常起病于童年早期.现着重介绍rTMS在ASD的康复过程中的应用.     

The effect of repetitive transcranial magnetic stimulation for insomnia: a systematic review and meta-analysis

BackgroundRepetitive transcranial magnetic stimulation (rTMS) might be a promising technique in treating insomnia. A comprehensive meta-analysis of the available literature is conducted to offer evidence.ObjectiveTo evaluate the efficacy and safety of rTMS for insomnia, either as monotherapy or as a complementary strategy.MethodsCENTRAL, PubMed, EMBASE, PsycINFO, CINAHL, PEDro, CBM, CNKI, WANFANG, and VIP were searched from earliest record to August 2019. Randomized control trials (RCTs) published in English and Chinese examining effects of rTMS on patients with insomnia were included. Two authors independently completed the article selection, data extraction and rating. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. The RevMan software was used for meta-analysis. The quality of the evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsA total of 36 trials from 28 eligible studies were included, involving a total of 2357 adult participants (mean age, 48.80 years; 45.33% males). Compared with sham rTMS, rTMS was associated with improved PSQI total score (SMD −2.31, 95% CI −2.95 to −1.66; Z = 7.01, P < 0.00001) and scores of seven subscales. Compared to other treatment, rTMS as an adjunct to other treatment was associated with improved PSQI total score (SMD −1.44, 95% CI −2.00 to −0.88; Z = 5.01, P < 0.00001), and may have effects on scores of seven subscales. Compared with other treatment, rTMS was associated with improved Pittsburgh sleep quality index (PSQI) total score (SMD −0.63, 95% CI −1.22 to −0.04; Z = 2.08, P = 0.04), and may have a better score in sleep latency, sleep disturbance and hypnotic using of seven subscales. In the three pair of comparisons, the results for polysomnography (PSG) outcomes were varied. In general, rTMS may improve sleep quality through increasing slow wave and rapid eye movement (REM) sleep. The rTMS group was more prone to headache than the sham or blank control group (RR 1.71, 95% CI 1.03 to 2.85; Z = 2.07, P = 0.04). No severe adverse events were reported. Reporting biases and low and very low grade of some evidences should be considered when interpreting the results of this meta-analysis.ConclusionsOur findings indicate that rTMS may be a safe and effective option for insomnia. Further international, multicenter, high-quality RCTs with more objective, quality of life related and follow-up assessments are needed.     

The effects of repetitive transcranial magnetic stimulation on depressive symptoms and the P300 event-related potential

Changes in the Hamilton Depression Rating Scale and the P₃₀₀ auditory event-related potential were assessed in 10 patients with depression before and after a treatment course of five daily sessions of 10?Hz repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex. The patients were initially randomly allocated either to an active or a placebo rTMS treatment. All patients received both types of treatment separated by an interval of 4?weeks. The median Hamilton score decreased by 7 points following active rTMS and by 1?point after sham (p=0.075). Active rTMS was associated with a significant increase in the P₃₀₀ amplitude compared with sham (p=0.02). There was no correlation between changes in P₃₀₀ measurements and the Hamilton scores after active treatment. We conclude that five daily sessions of left prefrontal rTMS treatment is not of sufficient duration to make a significant improvement in depressive symptoms.     

重复经颅磁刺激改善失眠患者主观睡眠质量的Meta分析

目的系统评价重复经颅磁刺激(rTMS)对失眠患者主观睡眠质量的疗效,为rTMS治疗失眠提供循证依据。方法系统检索PubMed、Embase、Cochrane Library、万方数据库、维普中文期刊数据库、中国生物医学文献数据库和中国期刊全文数据库,纳入关于rTMS治疗失眠或睡眠障碍的随机对照研究。由两名研究者独立筛选文献、提取数据,并对纳入文献的方法学质量进行评价。采用RevMan 5.2进行Meta分析,采用Stata 13.0分析发表偏倚。结果最终纳入13篇文献,共889例患者。Meta分析结果显示:rTMS治疗组睡眠质量改善的效果优于对照组(SMD=-1.11,95%CI:-1.46～-0.76,Z=6.22,P0.01)。亚组分析结果显示,针对原发性和继发性失眠患者,rTMS治疗组睡眠质量改善的效果均优于对照组(原发性:SMD=-1.22,95%CI:-1.72～-0.72,Z=4.77,P0.01;继发性:SMD=-1.04,95%CI:-1.55～-0.54,Z=4.04,P0.01)。高频和低频rTMS对患者睡眠质量评分的改善效果均优于对照组(高频:SMD=-0.44,95%CI:-0.76～-0.13,Z=2.73,P0.01;低频:SMD=-1.24,95%CI:-1.61～-0.86,Z=6.45,P0.01)。结论高频或低频rTMS联合常规治疗对失眠患者主观睡眠质量的改善效果更佳,对原发性和继发性失眠均有效。     

Short duration repetitive transcranial magnetic stimulation for tinnitus treatment: a prospective Asian study

Background

Tinnitus is a subjective auditory perception of sounds or noise not triggered by external auditory stimuli. To date, treatment in severe cases is generally unsatisfactory. Characteristic functional brain imaging changes associated with tinnitus include hyperactivity encompassing both the primary auditory cortex (AC) and the secondary or associative cortex. Brief repetitive transcranial magnetic stimulation (rTMS) trains applied to the scalp overlying the hyperactive left AC is known to produce moderate tinnitus attenuation.

Objective

Although Western studies have documented the value of rTMS in tinnitus treatment, we evaluate the efficacy of a short duration rTMS protocol for the first time in the Asian setting.

Method

Consecutive patients were recruited at our tinnitus clinic. Detailed history, examination, audiogram and baseline tinnitus scales were recorded. RTMS consisted of 1000 pulses/day at 1 Hz and 110% of the motor threshold, for five consecutive days over the left temporoparietal cortex. Tinnitus ratings were determined weekly for 4 weeks after rTMS.

Result

Fifteen patients completed the trial; none experienced significant side effects. Repeated measures ANOVA showed significant linear decrease in Tinnitus Handicap Inventory (THI) scores over the time period (F_(1,14) = 4.7, p = 0.04). However, none of the other parameters (severity, annoyance, effect on lifestyle and overall impression: visual analogue scale) showed beneficial outcomes.

Conclusions

Our findings point to a positive effect of short duration rTMS in tinnitus treatment using the THI. However, no significant benefits were demonstrated for other subjective patient ratings. Although well tolerated and convenient, short duration rTMS may prove inadequate for modulating maladaptive plastic changes at the cortical level, and our results suggest the need for delivery of more stimuli. Future studies will utilize at least 2000 pulses/day, in line with previous experience in Western settings.     

Efficacy of repetitive transcranial magnetic stimulation in depression: A review of the evidence

Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment in psychiatry. We reviewed all published evidence on the efficacy of this treatment option in depressive disorders. An extensive electronic and manual search for eligible research reports identified only 12 studies that met the predetermined criteria for inclusion. rTMS was administered differently in most studies, and patient characteristics varied widely. A formal meta-analysis of the studies was thus not possible. Instead, we conducted a qualitative evaluation of the included studies. The antidepressive efficacy was not consistent, and where efficacy was demonstrated, it was modest in most studies. Some patients had good but transient responses to rTMS. Treatment gains were not maintained beyond the treatment period. Comparisons with electroconvulsive therapy (ECT) indicated the superiority of ECT. More, larger and more carefully designed studies are needed to demonstrate convincingly a clinically relevant effect of rTMS. We conclude that there is insufficient evidence for rTMS as a valid treatment for depression at present.     

5Hz重复经颅磁刺激对抑郁症的治疗作用

目的 观察重复经颅磁刺激（rTMS）对抑郁症的影响.方法 通过对8例患者（男4例,女4例）进行治疗,rTMS对右侧前额叶部位的刺激（每次给予5 Hz,连续4.9 s的刺激;两次刺激间隔30 s,每次治疗10次刺激,每个疗程10次治疗,持续1个月）.结果 治疗后HAMD、CGI评分较治疗前显著下降,差异具有统计学意义（P〈0.01）.结论 每次3～5 min,用5 Hz爆发刺激模式,比常规高频刺激有更好的调节作用,且刺激时间短,刺激量减小,不良反应更小.     

Long-term follow-up study with repetitive transcranial magnetic stimulation (rTMS) in Parkinson's disease

Several studies have claimed the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in Parkinson's disease (PD). The rTMS therapy has to be repeated regularly to achieve a permanent effect but the side effects of long-term administration of low frequency rTMS are not known. Further, there is no information about its influence on the development of Parkinson's disease. Two different groups of patients with PD were compared in a retrospective study for 3 years. The first group (A) was treated with drugs, the second group (B) was treated with drugs + rTMS (1 Hz, 0.6 T, 100 stimuli per day for 7 days using a round coil). rTMS was repeated at least twice each year for 3 years. Symptoms of PD were assessed using the Graded Rating Scale. Although at the onset of the study group B patients had greater disease severity and were receiving higher doses of levodopa, this group (receiving rTMS) showed no deterioration in these parameters, whereas those in group A receiving drugs alone showed a marked deterioration. Hoehn–Yahr (H–Y) stages at the onset of the study and 3 years later were: group A: 1.93 ± 0.75, 3.03 ± 1.01; group B: 2.50 ± 0.83, 2.45 ± 0.62. The dose of levodopa (mg/day) was at the onset of trial and 3 years later was: group A: 124.4 ± 144.0, 555.5 ± 247.2; group B: 287.7 ± 217.1, 333.4 ± 181.0. The yearly increment in the scores was: group A: 1.308 ± 0.307 (P < 0.001), group B: 0.642 ± 0.389 (P < 0.1). Accordingly, this retrospective study using regularly repeated rTMS with 1 Hz for 7 days, at least twice yearly for 3 years, significantly slowed the development of Parkinson's disease. Unwanted side effects were not observed during the 3 years.     

三重刺激技术定量评价多系统萎缩患者重复经颅磁刺激治疗效果二例分析

研究背景既往研究显示,初级运动皮质予重复经颅磁刺激可以改善皮质脊髓束损害。本研究采用三重刺激技术定量评价2例以帕金森综合征为主要表现的多系统萎缩(MSA-P)患者重复经颅磁刺激前后皮质脊髓束功能变化,探讨重复经颅磁刺激对皮质脊髓束损害的改善作用。方法 2例MSA-P型患者(1例为62岁男性,1例为44岁女性),病程1年,均接受重复经颅磁刺激,采用小指展肌三重刺激技术波幅比和统一多系统萎缩评价量表第二部分(UMSARSⅡ)评价治疗前后皮质脊髓束功能和运动功能。结果 2例MSA-P型患者治疗前小指展肌三重刺激技术波幅比为28.30%和69.10%,UMSARSⅡ评分22和20分;治疗后即刻小指展肌三重刺激技术波幅比为58.40%和71.70%,UMSARSⅡ评分16和12分,其中例1随访至重复经颅磁刺激后2个月,治疗后1和2个月小指展肌三重刺激技术波幅比分别为90.70%和50.70%,UMSARSⅡ评分17和23分。结论采用三重刺激技术可以定量评价重复经颅磁刺激对MSA-P型患者皮质脊髓束损害的改善作用。     

重复经颅磁刺激治疗慢性失眠障碍的效果及影响因素

背景 慢性失眠障碍病程迁延反复,重复经颅磁刺激（rTMS）作为改善睡眠质量的物理治疗方法,关于其疗效与人格特征相关性的证据有限。目的 探讨rTMS治疗慢性失眠障碍的效果及其影响因素,为慢性失眠障碍的治疗提供参考。方法 选取2022年9月—2023年9月于绵阳市第三人民医院就诊的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的慢性失眠障碍患者46例。于治疗前进行艾森克人格问卷（EPQ）、汉密尔顿抑郁量表17项版（HAMD-17）和汉密尔顿焦虑量表（HAMA）评定,分别于治疗前、治疗第2周末和治疗结束1周后采用匹兹堡睡眠质量指数量表（PSQI）评定睡眠质量。结果 治疗第2周末,患者PSQI总评分及主观睡眠质量、睡眠潜伏期、睡眠持续时间、睡眠效率、睡眠干扰、日间功能障碍因子评分均低于治疗前,差异均有统计学意义（t=4.755～13.361,P均<0.01）,24例（54.35%）治疗有效。多元线性回归分析结果显示,内外向人格特征进入了回归方程（B=0.317,P<0.01）,可解释29.90%的总变异（R2=0.299）。结论 rTMS治疗可能有助于改善慢性失...     

A systematic review and meta-analysis of the use of repetitive transcranial magnetic stimulation for auditory hallucinations treatment in refractory schizophrenic patients

Background. The use of repetitive transcranial magnetic stimulation (rTMS) remains a promising therapeutic tool in the treatment of schizophrenia. Symptoms such as auditory hallucinations (AH) find contradictory results in many studies. Here we present an up-to-date systematic review and meta-analysis of rTMS in the treatment of AH in schizophrenia. Methods. We searched Pubmed-MEDLINE from 1999 to 2013 for double-blinded randomized sham-controlled trials that applied slow rTMS on the left temporoparietal cortex and assessed the outcome results using Hallucination Change Scale or Auditory Hallucination Rating Scale or Scale for Auditory Hallucinations (SAH). We identified 10 studies suitable for the meta-analysis. Results. We found a positive sized effect in favor of rTMS [random-effects model Hedges’ g = 0.011, I-squared = 58.1%]. There was some variability between study effect sizes, but the sensitivity analysis concluded that none of them had sufficient weight to singularly alter the results of our meta-analysis. Discussion. rTMS appears to be an effective treatment for AH. The left temporoparietal cortex seems to be the area in which rTMS is effective. Although meta-analysis is a powerful analytical tool, more studies must be conducted in order to obtain a more expressive sample size to perform a more accurate analytical approach.     

重复经颅磁刺激对抑郁障碍患者睡眠质量改善的临床研究

研究背景 目前抑郁障碍患病率呈逐年升高之趋势,综合性医院就诊的抑郁障碍患者多以躯体化症状为主诉,尤以睡眠障碍最为常见,改善睡眠质量成为迫切的需要.本研究探讨重复经颅磁刺激(rTMS)对改善抑郁障碍患者睡眠质量的疗效.方法 以躯体化症状就诊的抑郁障碍患者随机分为单纯药物治疗组(药物治疗组)和rTMS联合药物治疗组(联合治疗组),分别采用汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)评价两种治疗方法的疗效.结果 两种治疗方法在不同观察时间点,各项评分差异均有统计学意义(P=0.000),且治疗方法与观察时间点之间存在交互作用(均P=0.000).与药物治疗组相比,联合治疗组患者治疗1、2和4周时HAMA评分、HAMD总评分和躯体化症状评分降低(均P=0.000);治疗1周时睡眠障碍评分降低(P=0.001);治疗1和2周时抑郁症状评分降低(均P=0.000).与治疗前相比,药物治疗组患者各项评分除治疗后1周差异无统计学意义(P＞0.05)外,其余各观察时间点差异均有统计学意义(P=0.000);联合治疗组患者治疗后各项评分差异均有统计学意义(P=0.000).治疗后1、2和4周,两组治疗总有效率比较,联合治疗组[63.64％(14/22)、86.36％(19/22)、90.91％ (20/22)]高于药物治疗组[20％ (4/20)、55％ (11/20)、75％(15/20)],差异有统计学意义(均P=0.000).结论 重复经颅磁刺激联合药物治疗抑郁障碍患者起效早、效果好,尤其对睡眠质量的改善优于单纯药物治疗,可以提高抑郁障碍患者的治疗依从性.     

重复经颅磁刺激治疗迟发性运动障碍患者的疗效观察

目的:观察重复经颅磁刺激( rTMS)对慢性精神分裂症迟发性运动障碍(TD)患者的治疗效果.方法:运用rTMS对36例慢性精神分裂症TD患者进行治疗,共12周,用异常不自主运动量表( AIMS)评估. 结果:rTMS对TD患者的显效率为56.5％,治疗后AIMS评分显著下降[基线(9.1±2.8)分,治疗以后(3.4±...     

Left versus right repetitive transcranial magnetic stimulation in treating major depression: A meta-analysis of randomised controlled trials

Although the majority of randomised controlled trials suggest that major depressive disorder (MDD, major depression) and treatment-resistant depression can be effectively treated by applying either high- (HF) or low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the left and right dorsolateral prefrontal cortex (DLPFC), respectively, it is not clear which rTMS approach is more effective or safer. This systematic review and meta-analysis was conducted on randomised controlled trials on HF and LF rTMS applied to the left and right DLPFC, respectively, for the treatment of MDD. Eight randomised controlled trials composed of 249 patients were selected to compare the effects of LF (≤1 Hz) rTMS over the right DLPFC to HF (10–20 Hz) rTMS over the left DLPFC. The therapeutic effects of both approaches were similar (odds ratio (OR) = 1.15; 95% confidence interval = 0.65–2.03). Dropout analysis based on only two studies was insufficient to draw a conclusion on the tolerability of LF rTMS. The pooled examination demonstrated that both rTMS methods were equally effective therapies for MDD. However, considering that LF right-sided rTMS produces fewer side effects and is more protective against seizures, its clinical applicability shows greater promise and should be explored further.