Intermittent theta‐burst stimulation versus sham stimulation for suicidal ideation and psychiatric symptoms in depressive disorders: A systematic review and meta‐analysis of randomized controlled trials

Published October 13, 2026. Six small trials collectively favored iTBS for suicidal ideation, depression and anxiety symptoms, while sleep quality did not differ. The result is promising but provisional and does not establish an effect on suicide attempts, mortality or long-term recurrence.

Bilal M, Kumari M, Farooq SZ, Sajjad F, Ullah MS, Akif M, Iftikhar S, Saddique MN, Nazari MJ.
Psychiatry and Clinical Neurosciences Reports · Publication date: 2026-10-13
Added to site: 2026-10-19
DOI: 10.1002/pcn5.70427

Published October 13, 2026. Added to Neurofeedback.com October 19, 2026.

Modalities

iTBS, TMS

Clinical focus

Suicidal ideation, Depressive disorders, Evidence synthesis

Population

People with depressive disorders in randomized iTBS trials

Sample

6 trials; the suicidal-ideation analysis compared 181 active-iTBS participants with 157 sham participants

Intervention / method

The review pooled randomized sham-controlled iTBS trials and separately analyzed suicidal ideation, depression severity, anxiety severity and sleep quality.

Comparator

Active iTBS versus sham iTBS alongside standard treatment

Clinician summary

Suicidal ideation favored iTBS (SMD -0.51, 95% CI -0.93 to -0.09; I2 70%). Depression and anxiety also favored iTBS, while two-trial sleep quality was null. Leave-one-out analyses reduced heterogeneity, but the evidence base remained small and varied in protocols, outcomes and follow-up.

How to interpret the findings

Only six randomized trials were available, most with small samples. Populations, stimulation protocols, follow-up and suicidal-outcome constructs varied, follow-up was generally short and adverse-event reporting was too sparse and inconsistent for pooled safety analysis. The review does not establish prevention of suicide attempts or death.

Equipment and disclosures

Included trials used varying iTBS systems and protocols; no single manufacturer was attributed in this summary. No BrainMaster attribution.

The authors declared no conflicts of interest. No dedicated funding was identified in the checked full text. No indexed correction, retraction or concern relation appeared in the retained PubMed or Crossref records; this is a bounded check. AI-assisted review.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Repetitive transcranial magnetic stimulation for the treatment of restless legs syndrome · Positive with limitations
• Umbrella review of low-level light therapy: evidence across clinical conditions · Positive with limitations
• TMS-EEG Correlate of Suicidal Ideation in Individuals with Depression: A Multi-Site Synthesis. · Positive with limitations