Efficacy and safety of intermittent theta burst stimulation versus repetitive transcranial magnetic stimulation for patients with schizophrenia: a systematic review and meta-analysis.

OBJECTIVE

This meta-analysis compares intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) in treating schizophrenia, focusing on efficacy and safety.

METHODS

Data from seven randomised trials (N = 440) were analysed. Outcomes included symptom severity (PANSS scales), cognitive function and adverse events. Effect sizes were calculated using RevMan version 5.3.

RESULTS

No significant differences were observed for total psychopathology (SMD = -0.15), positive symptoms (SMD = 0.40) or general psychopathology (SMD = -0.58) (all p > 0.05). A reduction in negative symptoms was noted for iTBS compared to rTMS (SMD = -0.43, 95% CI: -0.82 to -0.03; p = 0.04; I2 = 70%). Three studies reported cognitive benefits with adjunctive iTBS (p < 0.05). Safety outcomes, including discontinuation rates (RR = 0.77) and adverse events (headache/dizziness/fatigue), showed no group differences (p = 0.26-0.54).

CONCLUSIONS

iTBS shows specific efficacy for schizophrenia-related negative symptoms versus rTMS, with comparable safety. Larger trials are needed to confirm clinical applicability.