Efficacy of High-Frequency Transcranial Magnetic Stimulation Therapy for Depression With Insomnia Symptoms: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.
Wenqing Yang, Songbin Chen, Xiaotong Li et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials assessed left dorsolateral prefrontal cortex-targeted high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for people with depression and insomnia symptoms. Seven studies included 709 participants. Compared with control, HF-rTMS improved sleep quality (standardized mean difference [SMD] 0.97 [95% CI 0.23 to 1.71], p = 0.01) and depressive symptoms (SMD 0.61 [95% CI 0.38 to 0.84], p < 0.00001). Evidence certainty was very low to low, and substantial heterogeneity affected sleep-quality results.
Key findings
- Sleep quality improved with HF-rTMS: SMD 0.97 [95% CI 0.23 to 1.71], p = 0.01.
- Depressive symptoms improved: SMD 0.61 [95% CI 0.38 to 0.84], p < 0.00001.
- Sleep latency showed a non-significant trend toward reduction: SMD 0.50 [-0.17 to 1.18], p = 0.14.
- Adverse reactions did not differ significantly between groups: risk ratio 1.09 [95% CI 0.80 to 1.48], p = 0.57.
Why it matters
Depression and insomnia symptoms can occur together, and this synthesis suggests that left DLPFC-targeted HF-rTMS may benefit both sleep quality and depressive symptoms. However, the evidence is very low to low certainty, with substantial variation in sleep-quality results. The findings therefore inform clinical understanding but do not establish a reliable treatment effect.
What to keep in mind
The evidence was rated very low to low certainty, and sleep-quality outcomes had substantial heterogeneity (I 2 = 91%). The authors also note methodological limitations and call for confirmation in high-quality trials.