In clinical practice, theta burst stimulation (TBS) presents as a more efficient and potentially more effective therapeutic modality than conventional repetitive transcranial magnetic stimulation (rTMS), as it allows for the delivery of more stimuli in less time and at similar intensities. To date, accelerated treatment plans according to various continuous (cTBS) and intermittent TBS (iTBS) protocols for depression have been proposed. To investigate which of the TBS protocols provided a favorable risk-benefit balance for individuals with depression, this systematic review and random-effects model network meta-analysis was conducted. The study outcomes included response rate (primary), depression symptom improvement, remission rate, all-cause discontinuation rate, incidence of switch to mania, and incidence of headache/discomfort at treatment site. In this meta-analysis, a total of 23 randomized controlled trials (n = 960, mean age = 41.88 years, with 60.78% females) were included. Approximately 69.57% of the trials included individuals with an exclusive diagnosis of major depressive disorder. The following six TBS protocols (target) were evaluated: cTBS (right-dorsolateral prefrontal cortex [R-DLPFC]), cTBS (R-DLPFC) + iTBS (left-DLPFC [L-DLPFC]), iTBS (L-DLPFC), iTBS (L-DLPFC) + iTBS (R-DLPFC), iTBS (left-dorsomedial prefrontal cortex) + iTBS (right-dorsomedial prefrontal cortex), and iTBS (occipital lobe). Compared to sham, cTBS (R-DLPFC) + iTBS (L-DLPFC), iTBS (L-DLPFC), and iTBS (occipital lobe) had a higher response rate (k = 23); cTBS (R-DLPFC) + iTBS (L-DLPFC) and iTBS (L-DLPFC) dominated in the depression symptom improvement (k = 23); and iTBS (L-DLPFC) had a higher remission rate (k = 15). No significant differences were found for all-cause discontinuation rate (k = 17), incidence of switch to mania (k = 7), and incidence of headache/discomfort at treatment site (k = 10) between any TBS protocols and sham. Thus, cTBS (R-DLPFC) + iTBS (L-DLPFC) and iTBS (L-DLPFC) demonstrate favorable risk-benefit balance for the treatment of depression.

在临床实践中，θ爆发刺激（TBS）比传统的重复经颅磁刺激（rTMS）更有效、可能更有效的治疗方式，因为它可以在更短的时间内以相似的强度传递更多的刺激。迄今为止，已经提出了根据各种连续（cTBS）和间歇性TBS（iTBS）抑郁症方案的加速治疗计划。为了调查哪种 TBS 方案为抑郁症患者提供了有利的风险收益平衡，进行了系统评价和随机效应模型网络荟萃分析。研究结果包括缓解率（主要）、抑郁症状改善、缓解率、全因停药率、转为躁狂的发生率以及治疗部位头痛/不适的发生率。在这项荟萃分析中，总共纳入了 23 项随机对照试验（n = 960，平均年龄 = 41.88 岁，其中 60.78% 为女性）。大约 69.57% 的试验纳入了被明确诊断为重度抑郁症的个体。评估了以下六种 TBS 协议（目标）：cTBS（右背外侧前额叶皮层 [R-DLPFC]）、cTBS (R-DLPFC) + iTBS（左 DLPFC [L-DLPFC]）、iTBS (L-DLPFC) 、iTBS (L-DLPFC) + iTBS (R-DLPFC)、iTBS（左背内侧前额叶皮层）+ iTBS（右背内侧前额叶皮层）和 iTBS（枕叶）。与假手术相比，cTBS (R-DLPFC) + iTBS (L-DLPFC)、iTBS (L-DLPFC) 和 iTBS（枕叶）具有更高的缓解率 (k = 23)； cTBS (R-DLPFC) + iTBS (L-DLPFC) 和 iTBS (L-DLPFC) 在抑郁症状改善中占主导地位 (k = 23)； iTBS (L-DLPFC) 的缓解率较高 (k = 15)。 任何 TBS 方案与假手术之间，全因停药率 (k = 17)、转为躁狂的发生率 (k = 7) 以及治疗部位头痛/不适的发生率 (k = 10) 均未发现显着差异。因此，cTBS（R-DLPFC）+ iTBS（L-DLPFC）和iTBS（L-DLPFC）显示出治疗抑郁症的有利风险收益平衡。