2025 American Academy of Neurology Abstract Website

Objective:

To assess the relative efficacy of various Non-Invasive Brain Stimulation Techniques used in the treatment of Unipolar Depression.

Background:

Depression is a major global health concern with limited treatment efficacy for many patients. Non-invasive brain stimulation (NIBS) techniques have emerged as promising interventions. While systematic reviews have evaluated these techniques against placebo, direct comparisons between NIBS methods remain scarce.

Design/Methods:

A thorough systematic search was conducted in the databases PubMed/MEDLINE, EMBASE, Scopus, Cochrane and ClinicalTrials.gov to identify RCTs focusing on NIBS interventions used in unipolar depression. The search included trials from the earliest available date up to July 2024. A Network meta-analysis was conducted to evaluate the efficacy of NIBS interventions used in treating unipolar Depression based on three outcomes: HAMD, BDI and the MADRS. Data were analysed using the R language for statistical computing and the ⁠ netmeta ⁠ package.

The pairwise treatment effects were calculated using the SMD as the effect measure. The network meta-analysis considered both direct and indirect comparisons. Subsequent analyses included ranking treatments based on their effectiveness, exploring direct versus indirect evidence through split network meta-analysis, and pairwise meta-analysis comparisons.

Results:

Our NMA evaluated multiple treatments across the BDI, MADRS, and HAMD with sample sizes of 1426, 2082, and 2479 respectively. ECT was most effective in reducing BDI scores (mean difference: -1.39, CI: -1.95 to -0.83), SNT led in MADRS reductions (mean difference: -1.76, CI: -2.83 to -0.70), and PET-guided rTMS showed the largest effect on HAMD (mean difference: -3.52, CI: -6.59 to -0.441).

Conclusions:

These findings underscore the efficacy of specific interventions like ECT for BDI, SNT for MADRS, and PET-guided rTMS for HAMD, suggesting that treatment approaches should be tailored to the depressive scale and patient symptom profiles.