Non-invasive Brain Stimulation and Light-based Therapies for Sleep Dysregulation in Major Depressive Disorder: Evidence From a Parameter-stratified Network Meta-analysis of Randomized Controlled Trials
Muneeb Ahmad Muneer1, Amatul Aala2, Dawood shah3, Rimsha Adnan4, Ayesha Amjad5, Faris Fayyaz4, Ameer Hamza6, Areeb Amjad5, Muhammad Subhan Saleem1, Amna Asif7, Farid Ullah8, Fahad Siddique Butt9, Prithvi Pillai10, Shanza Abbasi7, Dabbara Venkata Ramana11, Sai Venkata Manoj Kotharu11
1Allama Iqbal Medical College, 2Nishtar Medical University, 3Rehman Medical College, 4Dow University of Health Sciences, 5Fauji Foundation Hospital, 6Bahawal Victoria Hospital, 7Rawalpindi Medical University, 8MTI Khyber Teaching Hospital, 9Hameed Latif Hospital, 10PSG Institute of Medical Sciences and Research, 11Osmania Medical college
Objective:
To compare the efficacy of NIBS modalities and bright light therapy (BLT) on sleep outcomes in MDD using a network meta-analysis (NMA) of randomized controlled trials (RCTs).
Background:
Sleep disturbances are highly disabling in major depressive disorder (MDD), worsening outcomes and quality of life. Neuromodulation approaches, including non-invasive brain stimulation (NIBS) and light-based interventions, have shown promise, but their comparative effects on sleep remain unclear.
Design/Methods:
PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through July 2025 for RCTs assessing sleep quality, efficiency, or duration with validated measures. Eligible studies compared repetitive transcranial magnetic stimulation (rTMS), intermittent theta burst stimulation (iTBS), transcranial direct current stimulation (tDCS), or BLT against sham controls. Random-effects NMA was performed with sham as reference.
Results:
Eleven RCTs including 1,076 participants were analyzed. For sleep quality, rTMS at 10 Hz over the left dorsolateral prefrontal cortex (LDLPFC) with adjunctive drugs (MD = –2.49, 95% CI –3.86 to –1.12, p = 0.0004) and BLT at 10,000 Lux for 45 minutes/day (MD = –3.35, 95% CI –6.66 to –0.04, p = 0.0472) were superior to sham. For sleep efficiency, rTMS at 10 Hz LDLPFC (MD = 0.10, 95% CI 0.047 to 0.153, p = 0.0002) and tDCS at 2 mA bilateral DLPFC (MD = 0.05, 95% CI 0.0058 to 0.0942, p = 0.0266) improved outcomes, while BLT did not. For sleep duration, rTMS (SMD = 36.92, 95% CI 9.24 to 64.60, p = 0.0089) and tDCS (SMD = 19.15, 95% CI 3.66 to 34.64, p = 0.0154) increased outcomes, whereas lower-intensity BLT was inferior. No inconsistency was detected, though heterogeneity was high for sleep quality.
Conclusions:
rTMS and tDCS, when combined with pharmacological therapy, improve multiple sleep domains in MDD. BLT shows selective efficacy, enhancing quality but not efficiency or duration. These findings support integrating neuromodulation and light-based approaches into personalized treatment strategies.
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