Our systematic review and meta-analysis shows that information on blinding integrity in typical RCTs of rTMS for MD is rarely reported and reasons for this phenomenon remain unclear. Furthermore, our findings suggest that commonly used sham rTMS methods appear to adequately conceal treatment allocation, leading to acceptable levels of blinding integrity at study end. Nevertheless, the development of novel and optimized sham rTMS strategies such as electromagnetic sham (Rossi et al., 2007), focal electrical stimulation (Arana et al., 2008) or shielded magnetic coils (Sommer et al., 2006) is still a worthwhile endeavour.