Theta burst stimulation for suicidal ideation in depression: A systematic review and meta-analysis of efficacy and...

Suicidal ideation (SI) is common in major depressive disorder (MDD) and strongly associated with suicide risk. Current treatments often fail to provide rapid and sustained relief. This meta-analysis evaluated the effects of theta burst stimulation (TBS) on SI and depressive symptoms.

Six databases were systematically searched through March 2026 for randomized controlled trials evaluating TBS for SI in depression. Random-effects models were used to calculate pooled standardized mean differences (SMDs). Subgroup, meta-regression, and correlation analyses were conducted.

Eighteen studies were included, with 14 entering quantitative synthesis. TBS significantly reduced SI (SMD = -0.48, p < 0.001) and depressive symptoms (SMD = -0.66, p < 0.001). TBS was superior to sham and comparable, but not superior, to standard rTMS. Baseline depression severity significantly moderated anti-suicidal effects (β = -2.777, p = 0.007), although findings were sensitive to high-leverage studies. Improvements in SI and depressive symptoms were moderately correlated but not statistically significant (R = 0.57, p = 0.112). No serious adverse events were reported.

TBS may be an effective and time-efficient intervention for depression with SI. Given its shorter treatment duration, TBS may be particularly useful in settings requiring rapid SI relief. Improvements in SI and depressive symptoms may be partly independent, supporting separate assessment and treatment of SI. Future studies should prioritize SI as a primary outcome and investigate optimal stimulation timing parameters.