Background: Repetitive transcranial magnetic stimulation (rTMS) may be useful in the treatment of depression but results from trials have been inconclusive to date. Aims: To assess the efficacy of rTMS in treating depression. Method: We conducted a systematic review of randomised controlled trials that compared rTMS with sham in patients with depression. We assessed the quality of design of all studies and conducted a meta-analysis of data from trials with similar rTMS delivery. Results: We included a total of 14 trials. The quality of the included studies was low. Pooled analysis using the Hamilton Rating Scale for Depression showed an effect in favour of rTMS compared with sham after 2 weeks of treatment (standardised mean difference= -0.35; 95% CI -0.66 to -0.04), but this was not significant at the 2-week follow-up (standardised mean difference= -0.33; 95% CI -0.84 to 0.17). Conclusions: Current trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression. Declaration of interest: The study was funded by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spain (grant no. 00/10099). T.E.S. is involved in one of the studies included in this review and is also Secretary Treasurer of the International Society for Transcranial Stimulation.