Effects of continuous theta burst stimulation on patients with obsessive‒compulsive disorder (OCD): A systematic review and meta-analysis of randomized sham controlled trials.

Despite standard pharmacological and behavioral therapies, a significant proportion of patients with obsessive‒compulsive disorder (OCD) have a suboptimal or no response. Continuous theta burst stimulation (cTBS) is a novel variant of traditional transcranial magnetic stimulation (TMS) that has shown promising results in a wide array of behavioral disorders. To integrate the evidence of its role in OCD, we conducted a systematic review and meta-analysis of pertinent randomized controlled trials (RCTs). We conducted a comprehensive literature search from inception until June 2024 on PubMed, Google Scholar, PsycINFO, Embase, and clinical trial registries. Six RCTs were identified and included in our study. Data regarding obsessive‒compulsive symptoms, depression, and anxiety were extracted and analyzed via a random effects model. We found no significant differences between the active and sham groups regarding the change in obsessive‒compulsive symptoms, neither immediately posttreatment (p = 0.98) nor at follow-up (p = 0.83). Similarly, neither group was superior in alleviating concomitant anxiety and depression. Owing to the limited number of studies and their variability in terms of brain targets and the total number of pulses administered, we cannot definitively conclude the effectiveness of cTBS in patients with OCD. However, our research highlights it as a potentially safe treatment option with no serious side effects. Future investigators should aim to optimize intervention protocols and utilize neuronavigation techniques for accurate delivery of pulses to targeted brain loci. High-powered trials with sufficient sample sizes are needed to gain deeper insight into the effects of cTBS on primary and secondary clinical manifestations of OCD.