In adolescents, the only large randomised trial found TMS no better than sham
Ten studies of TMS for adolescent depression, two of them randomised: the pooled 41% response came mainly from uncontrolled studies, and "the only large-scale randomized trial suggests TMS is not more effective than sham stimulation".
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: The pooled effect and the null RCT point in different directions only if uncontrolled studies are read as evidence of efficacy, which the authors do not do. The evidence base in adolescents is small, and the one adequately powered sham-controlled trial was negative.
Significant findings
Sigrist and colleagues searched the literature on TMS for adolescent major depression, found 1,264 records, and were left with ten studies for quantitative synthesis, "of mainly uncontrolled studies"; only two were randomised. Individual patient data were available from five trials, all uncontrolled. Pooled across the aggregate data, symptoms fell from baseline to after treatment (standardised mean change 2.04, 95% confidence interval 1.46 to 2.61) and the pooled response rate was 41.30% (31.03 to 51.57).
Those numbers describe what happened to adolescents who were treated. They do not describe what TMS did, because without a sham arm the two cannot be separated. The authors put it directly: "To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted."
Worth asking
A 41% response in uncontrolled studies and a null result in the one large sham-controlled trial are not in conflict; they are the reason sham arms exist. For a teenager, what evidence with a sham comparison is the recommendation resting on?
Source
Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies — Sigrist C, Vöckel J, MacMaster FP, Farzan F, Croarkin PE, Galletly C (2022)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1007/s00787-022-02021-7
DOI: 10.1007/s00787-022-02021-7
How this was scored
- Study design
- Systematic review of observational studies
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- Yes
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 15, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 56 out of 100 on our published rubric. One caveat travels with that badge: The pooled effect and the null RCT point in different directions only if uncontrolled studies are read as evidence of efficacy, which the authors do not do. The evidence base in adolescents is small, and the one adequately powered sham-controlled trial was negative. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies — Sigrist C, Vöckel J, MacMaster FP, Farzan F, Croarkin PE, Galletly C (2022). Published in: Reputable peer-reviewed journal. DOI: 10.1007/s00787-022-02021-7. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of observational studies. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.