Efficacy and Safety of Theta Burst vs Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression: A Meta-Analysis of Randomized Controlled Trials

Chaomeng Liu; Li Li; Bing Li; Zhi Liu; Wenlong Xing; Kemeng Zhu; Wenqing Jin; Shuo Lin; Weihao Tan; Li Ren; Qinge Zhang

doi:10.1016/j.neurom.2023.08.009

Efficacy and Safety of Theta Burst vs Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression: A Meta-Analysis of Randomized Controlled Trials

Neuromodulation. 2023 Oct 12:S1094-7159(23)00742-0. doi: 10.1016/j.neurom.2023.08.009. Online ahead of print.

Authors

Chaomeng Liu¹, Li Li¹, Bing Li², Zhi Liu³, Wenlong Xing⁴, Kemeng Zhu¹, Wenqing Jin¹, Shuo Lin¹, Weihao Tan¹, Li Ren¹, Qinge Zhang⁵

Affiliations

¹ Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
² Hebei Provincial Mental Health Center, Baoding, China; Hebei Key Laboratory of Major Mental and Behavioral Disorders, Baoding, China; The Sixth Clinical Medical College of Hebei University, Baoding, China.
³ Department of Emergency, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China.
⁴ First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China.
⁵ Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China. Electronic address: zqe2016@ccmu.edu.cn.

PMID: 37831019
DOI: 10.1016/j.neurom.2023.08.009

Abstract

Objectives: Theta burst stimulation (TBS) is more energy- and time-efficient than is standard repetitive transcranial magnetic stimulation (rTMS). However, further studies are needed to analyze TBS therapy for its efficacy and safety compared with standard rTMS in treating depression. The aim of this meta-analysis was to compare TBS therapy with standard rTMS treatment regarding their safety and therapeutic effect on individuals with depression.

Materials and methods: Six data bases (Wanfang, the China National Knowledge Infrastructure, PubMed, Embase, Cochrane Library, and PsycINFO) were searched from inception till December 20, 2022. Two independent reviewers selected potentially relevant studies on the basis of the inclusion criteria, extracted data, and evaluated the methodologic quality of the eligible trials using the modified ten-item Physiotherapy Evidence Database scale per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Finally, ten comparable pairs of nine randomized controlled trials (RCTs) 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 simultaneously. This study was registered with the International Prospective Register of Systematic Reviews (CRD42022376790).

Results: Nine of the 602 RCTs, covering 1124 patients (616 who had TBS protocols applied vs 508 treated using standard rTMS), were included. Differences in response rates between the above two treatment modalities were not significant (OR = 1.01, 95% CI: 0.88-1.16, p = 0.44, I² = 0%, RE model; OR = 1.07, 95% CI: 0.87-1.32, p = 0.44, I² = 0%, QE model). Differences in adverse event rates between TBS and standard rTMS groups were not statistically significant.

Conclusions: TBS has similar efficacy and safety to standard rTMS for treating depression. Considering the short duration of daily stimulation sessions, this meta-analysis supports the continued development of TBS for treating depression.

Keywords: Depression; efficacy; meta-analysis; repetitive transcranial magnetic stimulation; theta burst stimulation.

Publication types

Review