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

Hsuan-Te Chu; Chih-Ming Cheng; Chih-Sung Liang; Wen-Han Chang; Chi-Hung Juan; Ying-Zu Huang; Jia-Shyun Jeng; Ya-Mei Bai; Shih-Jen Tsai; Mu-Hong Chen; Cheng-Ta Li

doi:10.1016/j.pnpbp.2020.110168

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

Prog Neuropsychopharmacol Biol Psychiatry. 2021 Mar 2:106:110168. doi: 10.1016/j.pnpbp.2020.110168. Epub 2020 Nov 7.

Authors

Hsuan-Te Chu¹, Chih-Ming Cheng², Chih-Sung Liang³, Wen-Han Chang⁴, Chi-Hung Juan⁵, Ying-Zu Huang⁶, Jia-Shyun Jeng⁴, Ya-Mei Bai⁷, Shih-Jen Tsai⁷, Mu-Hong Chen⁸, Cheng-Ta Li⁹

Affiliations

¹ Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
² Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
³ Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
⁶ Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁷ Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁸ Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁹ Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ctli2@vghtpe.gov.tw.

PMID: 33166668
DOI: 10.1016/j.pnpbp.2020.110168

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Efficacy; Major depression; Meta-analysis; Theta-burst stimulation; Tolerability.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Depressive Disorder, Major / diagnosis
Depressive Disorder, Major / physiopathology*
Depressive Disorder, Major / therapy*
Dorsolateral Prefrontal Cortex / physiopathology*
Humans
Randomized Controlled Trials as Topic / methods
Theta Rhythm / physiology*
Transcranial Magnetic Stimulation / methods*
Treatment Outcome