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

This meta-analysis compares intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) in treating schizophrenia, focusing on efficacy and safety. Data from seven randomised trials (<i>N</i> = 440) were analysed. Outcomes included symptom severity (PANSS scales), cognitive function and adverse events. Effect sizes were calculated using RevMan version 5.3. No significant differences were observed for total psychopathology (SMD = −0.15), positive symptoms (SMD = 0.40) or general psychopathology (SMD = −0.58) (all <i>p</i> &gt; 0.05). A reduction in negative symptoms was noted for iTBS compared to rTMS (SMD = −0.43, 95% CI: −0.82 to −0.03; <i>p</i> = 0.04; <i>I</i>² = 70%). Three studies reported cognitive benefits with adjunctive iTBS (<i>p</i> &lt; 0.05). Safety outcomes, including discontinuation rates (RR = 0.77) and adverse events (headache/dizziness/fatigue), showed no group differences (<i>p</i> = 0.26–0.54). iTBS shows specific efficacy for schizophrenia-related negative symptoms <i>versus</i> rTMS, with comparable safety. Larger trials are needed to confirm clinical applicability. iTBS is a safe and effective treatment option, potentially offering more effective relief of negative symptoms compared to rTMS.iTBS outperforms rTMS in reducing negative symptoms.In terms of total psychopathology, positive symptoms or general psychopathology, no significant differences were found between the groups. iTBS outperforms rTMS in reducing negative symptoms. In terms of total psychopathology, positive symptoms or general psychopathology, no significant differences were found between the groups.