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Depression among young populations remains a major public health concern with limited treatment options. While repeated transcranial magnetic stimulation (rTMS) benefits adults with depression, its efficacy and safety in younger populations are unclear. This meta-analysis evaluated TMS for depression among children, adolescents and young adults. We searched PubMed, WanFang, CNKI, PsychINFO, EMBASE, the Cochrane Library, and Web of Science up to February 2025 for RCTs comparing active any type of TMS with sham/no stimulation in depressed children and youths. Data extraction, quality assessment, and synthesis via random-effects models were performed. The primary outcome was the depression scale score changes; secondary outcomes included safety and adverse events. 34 RCTs ( n = 2705) indicated that TMS was significantly effective in reducing depression severity (SMD = −1.55, 95 % CI: −1.88, −1.23, p < 0.001, I 2 = 93 %). In pairwise comparisons, the high-frequency repetitive TMS (HF-rTMS) showed the largest effect (SMD = −1.90, 95 % CI: −2.42, −1.37, p < 0.001). Low-frequency rTMS and bilateral TMS showed smaller effects. Intermittent theta-burst stimulation (iTBS) effects were not significant. Subgroup analysis revealed that efficacy varied by diagnostic criteria and control group intervention. Safety assessments revealed that TMS was generally safe (OR = 1.713, 95 % CI: 1.422, 2.064, p < 0.001). Our meta-analysis demonstrates that TMS is safe and effective for depressed children and youths, particularly HF-rTMS. Further research is needed to confirm iTBS efficacy. These findings highlight the importance of optimizing TMS protocols and considering patient-specific factors to improve outcomes in youth with depression. • First systematic review and meta-analysis of TMS protocols (HF-rTMS, LF-rTMS, bilateral TMS, iTBS) in youth with depression. • High-frequency rTMS superior to other protocols. • Diagnostic criteria and control group intervention modulate TMS efficacy. • Safe profile: Mild, transient adverse events with active TMS; no serious complications.
Wang et al. (Mon,) studied this question.