Efficacy and safety of theta burst versus repetitive transcranial magnetic stimulation for major depressive disorder: a meta- analysis of randomized controlled trials

Abstract

Abstract Background: Theta burst stimulation (TBS) is more energy- and time-efficient than standard repetitive transcranial magnetic stimulation (rTMS). However, further studies are needed to analyze TBS therapy for its efficacy and safety compared to standard rTMS for major depressive disorder (MDD). The aim of this meta-analysis was to compare TBS therapy and standard rTMS treatment regarding their safety and therapeutic effect on individuals with MDD. Methods: Six databases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase, Cochrane Library, and PsycINFO) were searched from inception till November 20, 2022. Two independent reviewers selected potentially relevant studies based on the inclusion criteria, extracted data, and evaluated the methodological quality of the eligible trials using the modified 10-item Physiotherapy Evidence Database scale per PRISMA guidelines. Finally, ten comparable pairs of 9 randomized controlled trials were included for meta-analysis. Summary odds ratios (ORs) of the rates of response, remission, and adverse events were simultaneously calculated using quality-effects (QE) and random-effects (RE) models. Changes in depression scores associated with antidepressant effects were expressed using standardized mean differences (SMDs) simultaneously. This study was registered with PROSPERO (CRD42022376790). Results: Nine of the 602 RCTs, covering 1196 cases (616 subjected to TBS protocols vs. 580 treated using standard rTMS), were enrolled. Differences in response rates between the above two treatment modalities were not significant (OR = 1.03, 95% CI: 0.90–1.18, P > 0.05, I2 = 4%, RE model; OR = 1.09, 95% CI: 0.90–1.32, P > 0.05, I2 = 4%, QE model). Differences in adverse event rates between TBS and standard rTMS groups were not statistically significant. Conclusion: TBS has similar efficacy and safety as standard rTMS for treating MDD. In light of the short duration of daily stimulation sessions, this meta-analysis supports the continued development of TBS for treating depression.