Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation as Treatment of Poststroke Depression: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: Previous studies showed that the application of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) during stroke rehabilitation improve the depression symptoms in poststroke depression (PSD). However, some studies showed inconsistent results. The study was designed to make a meta-analysis to evaluate the effect of noninvasive brain stimulation (tDCS and rTMS) on PSD. METHODS: Articles published before July 2021 were searched in databases PubMed, Web of Science, and Google Scholar. STATA 12.0 software was utilized to make meta-analysis. We extracted or calculated mean values and SD of reduction or increase rate of depression-related scales. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated as effect size. RESULTS: The study showed increased immediate and long-term improvement in depression in rTMS group compared with sham rTMS group after treatment with random-effects models (immediate SMD=4.92, 95% CI=2.69-7.15, I2 =95.2%, P -value for Q test <0.001; long term SMD=7.21, 95% CI=3.50-10.92, I2 =93.9%, P -value for Q test <0.001). Meta-analysis showed increased substantially immediate improvement in depression in tDCS group compared with sham tDCS group with a random effect model (SMD=5.30, 95% CI=1.30-9.30, I2 =97.3%, P- value for Q test <0.001). CONCLUSIONS: rTMS and tDCS were demonstrated to be effective and safe treatment techniques for PSD. More large-scale studies were essential to explore the effect of rTMS with different frequencies and tDCS on PSD.