Intermittent theta burst beat sham on response and remission, with no more headache, dropout or mania
Across 23 randomised trials in 960 people, intermittent theta burst to the left prefrontal cortex beat sham on response and remission, with no excess of dropout, headache or switch to mania.
Well-supported by good-quality research. how we score evidence
Caveat on this rating: Small trials pooled across six protocols that differ in target and dose; the pooled safety comparisons (k = 7 for mania, k = 10 for headache) are thin. Favourable does not mean settled.
Significant findings
Theta burst stimulation delivers more pulses in less time than conventional rTMS, which is why it is the form most likely to be offered now. Kishi and colleagues pooled 23 randomised trials, 960 people, mean age 41.9, 61% women, about 70% of the trials in people with major depressive disorder only. Six protocols were compared, differing in which side of the prefrontal cortex was stimulated and whether the pattern was intermittent or continuous.
Against sham, intermittent theta burst to the left dorsolateral prefrontal cortex, and the combination of continuous right plus intermittent left, had higher response rates and "dominated in the depression symptom improvement"; intermittent left alone also had a higher remission rate. On safety, "no significant differences were found for all-cause discontinuation rate, incidence of switch to mania, and incidence of headache/discomfort at treatment site between any TBS protocols and sham." The authors' conclusion is that those two protocols "demonstrate favorable risk-benefit balance for the treatment of depression".
Worth asking
The comparisons are against sham, in small trials, pooled across protocols that differ in target and dose. That supports "this works and is tolerated". It does not settle which protocol or how many sessions. Which one is on offer, and how does the clinic check it is working at the halfway point?
Source
Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis — Kishi T, Ikuta T, Sakuma K, Hatano M, Matsuda Y, Wilkening J (2024)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1038/s41380-024-02630-5
DOI: 10.1038/s41380-024-02630-5
How this was scored
- Study design
- Meta-analysis of randomised trials
- Funding
- Funding not disclosed
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 960
- Preregistered
- not recorded
- Conflicts disclosed
- Yes
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 15, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "strong evidence". Well-supported by good-quality research. It scores 73 out of 100 on our published rubric. One caveat travels with that badge: Small trials pooled across six protocols that differ in target and dose; the pooled safety comparisons (k = 7 for mania, k = 10 for headache) are thin. Favourable does not mean settled. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis — Kishi T, Ikuta T, Sakuma K, Hatano M, Matsuda Y, Wilkening J (2024). Published in: Top-tier peer-reviewed journal. DOI: 10.1038/s41380-024-02630-5. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Meta-analysis of randomised trials. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.