Efficacy and safety of theta-burst stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis

Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder characterized by intrusive obsessions and repetitive, compulsive behaviors that are difficult to inhibit. Several studies have evaluated the efficacy of theta-burst stimulation (TBS) for alleviating OCD symptoms, reporting potential outcomes in both symptom reduction and functional improvement. This study aimed to synthesize evidence from published randomized clinical trials (RCTs) regarding the clinical effectiveness of TBS in patients with OCD. We searched PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase databases. A total of eight RCTs and one open-label study were included, each comparing TBS with sham stimulation in relation to the severity of obsessive and compulsive symptoms. The primary measure was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) between two groups from baseline to the endpoint (immediate effect) and from baseline to the end of follow-up period (long-term effect). The secondary outcome was depressive symptoms reported by The Hamilton Depression Rating Scale (HAM-D). Continuous outcomes were pooled as mean differences (MDs), while the dichotomous outcomes were pooled as risk ratios (RRs). This review included eight RCTs and one open-label study, comprising a total of 305 patients. According to the immediate action of TBS, it showed significant improvement in only the obsession sub-scale (MD = -1.04, 95%CI [-1.87, -0.22], p = 0.01, I 2 = 0%). While according to the long-term action, TBS showed significant improvement in 'obsession' sub-scale (MD = -1.63, 95%CI [-2.81, -0.44], p = 0.007, I² = 31%) and 'compulsion' sub-scale (MD = -1.68, 95%CI [-2.57, -0.8], p = 0.0002, I² = 0%), respectively. Also, it showed a significant reduction of HAM-D (MD = -2.16, 95%CI [ -3.89, -0.43], p = 0.01, I 2 = 15%). The results showed that TBS could be effective as an adjunctive treatment for OCD in relieving the obsessive-compulsive symptoms, especially the long-term action with well-tolerated adverse effects.