Systematic review and meta-analysis on the efficacy and safety of combining repetitive transcranial magnetic stimulation with sertraline for adolescent depression in China
In brief
Sertraline plus brain stimulation raised teen depression response rates 18% in Chinese trials
Across 24 Chinese randomized trials involving 2,155 adolescents, adding repetitive magnetic stimulation to sertraline was linked to lower depression scores and an 18% higher response rate than sertraline alone. Mild side effects were slightly more common, while cognitive gains rested on just three studies; high inconsistency, publication bias and low-to-moderate certainty mean benefits may be overstated and need broader trials.
- Journal
- Frontiers in psychiatry (Q1)
- Published
- 22 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Hongyi Sun, Lin Zhang, Jing Hu, Jing Li, Zhong Zheng
- PMID
- 42991802
- DOI
- 10.3389/fpsyt.2026.1893010
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 9 November 2026): Meta-analysis of rTMS augmentation for adolescent depression
Abstract
BACKGROUND: Adolescent depression is a global health challenge. While selective serotonin reuptake inhibitors (SSRIs) like sertraline are primary treatments, their efficacy is often limited. This meta-analysis evaluates the efficacy, neurocognitive impact, and safety of adjunctive repetitive transcranial magnetic stimulation (rTMS) combined with sertraline in adolescents. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases including PubMed (which also covers MEDLINE), Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, and Weipu, were searched up to June 2025. Randomized controlled trials (RCTs) comparing rTMS plus sertraline versus sertraline monotherapy in adolescents were included. The primary outcomes were depressive symptom reduction (measured by HAMD-17 and HAMD-24) and clinical response rates. Secondary outcomes included cognitive function (Montreal Cognitive Assessment, MoCA) and adverse event. RESULTS: Twenty-four RCTs (N = 2,155), all conducted in China and published in Chinese, were included. Combination therapy significantly reduced depressive symptoms (HAMD-17: SMD = -1.06; HAMD-24: SMD = -1.39) and improved response rates risk ratio (RR = 1.18). The pooled analysis of three studies suggested that adjunctive rTMS may improve MoCA scores (SMD = 0.99); however, the certainty of evidence was low. The combination group had a slightly higher incidence of mild adverse events (RR = 1.21). Significant heterogeneity (I2>80%) and publication bias were noted; the GRADE certainty of evidence ranged from very low to moderate. Meta-regression showed treatment duration did not moderate symptom reduction. Sensitivity analysis identified extreme protocols as the primary source of heterogeneity; excluding them yielded a pooled effect of SMD = -0.74 (I2 = 17%). CONCLUSION: Adjunctive rTMS may enhance clinical response and may improve cognitive function in sertraline-treated adolescents, with an acceptable safety profile. The cognitive finding was based on only three studies and low-certainty evidence. Given the very-low-to-moderate GRADE certainty, high heterogeneity, and geographic restriction, the effects may be overestimated. Standardized parameters appear crucial. Future multinational, sham-controlled trials utilizing updated risk-of-bias frameworks are warranted to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251118447.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.