A Systematic Review of Accelerated Intermittent Theta Burst Stimulation (iTBS) Versus Daily Repetitive Transcranial Magnetic Stimulation (rTMS) for Treatment-Resistant Depression: Is Shorter Really Better?

Treatment-resistant depression (TRD) presents a major clinical challenge, with a significant proportion of patients failing to respond to standard therapies. Among the neuromodulation options available, repetitive transcranial magnetic stimulation (rTMS) has been widely studied and approved, though it requires daily sessions over several weeks. Intermittent theta burst stimulation (iTBS), particularly in accelerated formats, offers a faster, time-efficient alternative that may maintain or enhance clinical outcomes. This systematic review synthesizes evidence from 25 studies comparing accelerated iTBS protocols to standard daily rTMS in adult TRD populations, with attention to efficacy, cognitive impact, tolerability, and logistical feasibility. Our findings suggest that accelerated iTBS is non-inferior to rTMS in terms of antidepressant outcomes, with comparable cognitive safety and fewer barriers to access. By reducing treatment duration without compromising results, accelerated iTBS represents a compelling option in the evolving landscape of depression management and may offer particular advantages for patients with limited access to extended care.