# Efficacy and safety of intermittent theta-burst stimulation versus continuous theta-burst stimulation for major depressive disorder and bipolar depression: a systematic review

## TL;DR

This review compares the effectiveness and safety of two types of brain stimulation for depression, finding some differences but calling for more research.

## Contribution

The study systematically compares intermittent and continuous theta-burst stimulation for depression, highlighting gaps in current evidence.

## Key findings

- Daily iTBS showed better antidepressant effects than daily cTBS in MDD with similar safety.
- Accelerated cTBS had better anxiolytic and anti-suicidal effects than accelerated iTBS in MDD.
- More research is needed due to limited studies and small sample sizes.

## Abstract

The therapeutic efficacy and safety profiles of daily or accelerated intermittent theta-burst stimulation (iTBS) in comparison to daily or accelerated continuous theta-burst stimulation (cTBS) for patients with major depressive disorder (MDD) or bipolar depression (BD) remain inadequately explored, respectively. This systematic review evaluates the efficacy, safety, and tolerability of daily or accelerated iTBS compared to daily or accelerated cTBS in patients with MDD or BD.

A comprehensive search was conducted in both Chinese (WanFang, China National Knowledge Infrastructure) and English (PubMed, EMBASE, PsycINFO, Cochrane Library) databases to identify randomized controlled trials (RCTs) examining the efficacy and safety of daily or accelerated iTBS compared to daily or accelerated cTBS in patients with MDD or BD.

Three studies (n = 87) investigated the efficacy, safety, and tolerability of daily iTBS versus daily cTBS (1 RCT, n = 30) in patients with MDD, and accelerated iTBS versus accelerated cTBS (2 RCTs, n = 57) in patients with MDD or BD. In patients with MDD, daily iTBS outperformed daily cTBS in terms of antidepressant efficacy, with comparable safety and tolerability profiles (1 RCT). Accelerated cTBS demonstrated superior anxiolytic (1 RCT) and anti-suicidal efficacy (1 RCT) compared to accelerated iTBS in MDD, with similar antidepressant efficacy, safety, and tolerability profiles for patients with MDD or BD (2 RCTs).

Among the limited number of available studies, the efficacy and safety of daily or accelerated iTBS compared to daily or accelerated cTBS in patients with MDD or BD were uncertain. Future research with larger sample sizes and standardized assessments is essential to confirm these findings.