Efficacy of High‐Frequency Transcranial Magnetic Stimulation Therapy for Depression With Insomnia Symptoms: A Systematic Review and Meta‐Analysis Based on Randomized Controlled Trials

Background This meta‐analysis evaluated the efficacy of high‐frequency repetitive transcranial magnetic stimulation (HF‐rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) in patients with comorbid depression and insomnia. Methods This analysis incorporated 7 studies, involving 709 subjects (control: 342; repetitive transcranial magnetic stimulation [rTMS]: 367). All included studies employed left DLPFC‐targeted HF‐rTMS. Treatment effectiveness for comorbid depression and insomnia was assessed. Subgroup analyses were conducted to explore possible sources of heterogeneity. Results HF‐rTMS significantly improved sleep quality (standardized mean difference [SMD] [95% confidence interval (CI)]: 0.97 [0.23 to 1.71], p = 0.01) and depressive symptoms (0.61 [0.38 to 0.84], p < 0.00001). There was a non‐significant trend toward reduced sleep latency (0.50 [−0.17 to 1.18], p = 0.14). No significant difference in adverse reactions was observed (risk ratio [95% CI]: 1.09 [0.80 to 1.48], p = 0.57). Substantial heterogeneity was identified for the Pittsburgh Sleep Quality Index outcomes ( I 2 = 91%). Subgroup analyses indicated that this heterogeneity was attributed to variations in stimulation frequency and baseline antidepressant use. Conclusion Very‑low to low certainty evidence suggests that left DLPFC‑targeted HF‑rTMS may improve sleep quality and depressive symptoms in patients with depression and insomnia symptoms, with a favorable safety profile. However, due to substantial heterogeneity and methodological limitations, these findings should be considered exploratory and warrant confirmation by future high‑quality trials.