Efficacy and tolerability of theta-burst stimulation for major depression: A systematic review and meta-analysis

• Published in: Progress in neuro-psychopharmacology & biological psychiatry 2021-03, Vol.106, p.110168-110168, Article 110168
• Main Authors: Chu, Hsuan-Te, Cheng, Chih-Ming, Liang, Chih-Sung, Chang, Wen-Han, Juan, Chi-Hung, Huang, Ying-Zu, Jeng, Jia-Shyun, Bai, Ya-Mei, Tsai, Shih-Jen, Chen, Mu-Hong, Li, Cheng-Ta
• Format: Article
• Language: English
• Subjects: Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - physiopathology; Depressive Disorder, Major - therapy; Dorsolateral Prefrontal Cortex - physiopathology; Efficacy; Humans; Major depression; Meta-analysis; Randomized Controlled Trials as Topic - methods; Theta Rhythm - physiology; Theta-burst stimulation; Tolerability; Transcranial Magnetic Stimulation - methods; Treatment Outcome
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2020.110168

Repetitive transcranial magnetic stimulation (rTMS) is the current treatment option for major depression (MD). Theta-burst stimulation (TBS), a variation of rTMS, affords a short stimulation duration, low stimulation pulse intensity, and possibility to improve rTMS efficiency. This systematic review and meta-analysis examined the studies on efficacy and tolerability of TBS in patients with MD. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the literature from 1990 until May 24, 2020, and performed a random-effects meta-analysis by including response and remission rates of depression and dropout rates as main outcome measures. In total, 10 studies including 6 randomized controlled trials (RCTs; n = 294) and 4 uncontrolled clinical trials (non-RCTs; n = 297) were included. The overall effect size of response rate and remission rates were 0.38 (95% confidence interval [CI]: 0.29–0.48) and 0.20 (95% CI: 0.13–0.29), respectively. Notably, the TBS group showed favorable efficacy without major adverse events. TBS treatment was more efficient in terms of time and energy than the standard rTMS was. Our meta-analysis provided evidence that the application of TBS to the dorsolateral prefrontal cortex is associated with significant antidepressant effects along with favorable tolerability. •TBS applied to the dorsolateral prefrontal cortex is associated with significant antidepressant effects and favorable tolerability.•TBS showed medium treatment effect of response rates and remission rates.•Low stimulation intensities, high number of pulses per session, short treatment periods, and iTBS might be the optimal parameters of TBS protocols.