Comparative efficacy of multiple non-invasive brain stimulation to treat major depressive disorder in older patients: A systematic review and network meta-analysis study based on randomized controlled trials

Background: Major depressive disorder (MDD) is prevalent among older patients and is frequently associated with cognitive decline and a reduced quality of life. Non-invasive brain stimulation (NIBS) techniques show promise for treating MDD, but their comparative efficacy and safety older populations remain unclear. This study aimed to compare the efficacy and cognitive effects of various NIBS techniques in treating MDD in older patients.

Methods: We searched the PubMed, EMBASE, Cochrane Library, and Web of Science core databases from inception to March 2024. Seventeen randomized controlled trials (RCTs) were included.

Results: Surfaces under the cumulative ranking curve (SUCRA) values were used to rank the interventions. The SUCRA rankings for the Hamilton Depression Rating Scale (HDRS) outcomes indicated that repetitive transcranial magnetic stimulation (rTMS) (89.0 %) had the highest efficacy, followed by transcranial direct current stimulation (tDCS) (68.7 %). rTMS demonstrated significantly superior efficacy compared with bilateral electroconvulsive therapy (BL ECT) and right unilateral electroconvulsive therapy (RUL ECT). Theta burst stimulation (TBS) had the highest response rate (69.6 %), followed by rTMS (61.8 %). Based on the Mini-Mental State Examination, rTMS (86.4 %) ranked the highest, with RUL ECT showing significantly better outcomes than BL ECT.

Conclusion: NIBS, particularly rTMS and TBS, may offer effective treatment options for older patients with MDD. Further research with larger sample sizes and longer follow-up periods is required to validate these findings and inform clinical practice.