Overview
As part of my ongoing training in evidence synthesis and systematic review methodology through the Meta-Analysis Academy programme, I registered a systematic review and meta-analysis protocol in PROSPERO, the international prospective register of systematic reviews.
PROSPERO Registration Number: CRD420261419829
Title: Intermittent Theta Burst Stimulation versus High-Frequency rTMS for Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
The review evaluates the comparative efficacy and tolerability of intermittent theta burst stimulation (iTBS) and conventional high-frequency repetitive transcranial magnetic stimulation (10 Hz rTMS) in adults with Major Depressive Disorder (MDD).
Background
Major Depressive Disorder remains one of the leading causes of disability worldwide. While pharmacological and psychological interventions continue to play a central role in treatment, neuromodulation techniques have emerged as an important therapeutic option, particularly for patients with treatment-resistant depression.
Intermittent theta burst stimulation (iTBS) is a newer transcranial magnetic stimulation protocol capable of delivering treatment in only a few minutes per session while potentially maintaining clinical outcomes comparable to conventional high-frequency repetitive transcranial magnetic stimulation (rTMS).
This review focuses specifically on randomised controlled trials directly comparing iTBS and 10 Hz rTMS applied to the left dorsolateral prefrontal cortex, aiming to provide a clearer and more clinically relevant estimate of their comparative effectiveness and safety.
Personal and Professional Context
This project reflects a longstanding interest in the intersection between neuroscience, clinical medicine, mental health, and chronic pain.
Throughout my professional journey, I have worked across family medicine, chronic pain management, behavioural health, telemedicine, and healthcare innovation. These experiences repeatedly highlighted the importance of understanding how brain function influences mood, cognition, behaviour, attention, perception, and the experience of pain.
My interest in neuromodulation extends beyond depression itself. Technologies such as intermittent theta burst stimulation and repetitive transcranial magnetic stimulation provide a unique opportunity to study brain networks in a clinically meaningful way. By applying controlled electromagnetic stimulation to specific cortical regions, these techniques contribute to our understanding of how neural circuits are involved in emotional regulation, executive function, attention, and symptom generation.
The growing body of evidence in this field supports a more integrated view of health, where conditions such as depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and chronic pain may share overlapping neurobiological pathways. Advances in neuroimaging, network neuroscience, and neuromodulation have increasingly demonstrated that many of these conditions involve alterations in functional connectivity across distributed brain networks rather than isolated dysfunction of a single region.
For this reason, the study of transcranial magnetic stimulation is particularly relevant to my broader academic interests in clinical neuroscience and pain medicine. It offers a practical and evidence-based framework for exploring the relationships between neuroelectrical activity, neurochemical signalling, behaviour, cognition, and symptom perception.
Beyond its clinical implications, this review represents an opportunity to deepen the understanding of how modern neuroscience can inform patient care and contribute to a more integrated approach to mental health and chronic pain management.
Objectives
The primary objective is to evaluate differences in depressive symptom improvement between intermittent theta burst stimulation and conventional high-frequency rTMS using validated outcome measures.
Secondary outcomes include:
- Response rates
- Remission rates
- Treatment discontinuation
- Serious adverse events
- Safety outcomes reported by the original studies
Research Team
This review is conducted by an international multidisciplinary team of physicians and health researchers from Brazil, Italy, and other collaborating institutions.
Review Guarantor and Contact:
Dr Fábio Luiz Vieira
Family Physician
ORCID: 0000-0003-2711-2769
Current Status
The protocol was registered in PROSPERO on 10 June 2026 and the review is currently ongoing.
The project forms part of my broader engagement with evidence-based medicine and systematic review methodology, developed in the context of the Meta-Analysis Academy programme.
External Resources
- PROSPERO Registration: CRD420261419829
Research Areas Related to This Project:
- Clinical Neuroscience
- Mental Health and ADHD
- Chronic Pain
- Family Medicine
- Evidence-Based Medicine
- Systematic Reviews and Meta-Analysis
Related Projects
Advanced Training in Systematic Reviews and Meta-Analysis
This review was developed as part of the Meta-Analysis Academy programme, an international training initiative in evidence synthesis methodology.
Pain Medicine & Clinical Neuroscience
Explore the broader context of neuroscience and pain medicine within Dr Vieira’s clinical and academic work.
Research & Academic Activities
Overview of academic publications, research projects, and scholarly contributions.