Non-invasive brain stimulation combined with psychosocial intervention for depression: a systematic review and meta-analysis

Objectives This review investigates the efficacy and safety of non-invasive brain stimulation (NIBS) combined with psychosocial intervention on depressive symptoms. Materials and methods We systematically searched five electronic databases from their inception to June 2021: PubMed, Embase, PsycINFO, Web of Science, and Medline. Randomized or non-randomized clinical trials in which NIBS plus psychosocial intervention was compared to control conditions in people with depressive symptoms were included. Results A total of 17 eligible studies with 660 participants were included. The meta-analysis results showed that NIBS combined with psychosocial therapy had a positive effect on moderate to severe depression ([SMD = - 0.46, 95%CI (- 0.90, - 0.02), I-2 = 73%, p < .01]), but did not significantly improve minimal to mild depression ([SMD = - 0.12, 95%CI (- 0.42, 0.18), I-2 = 0%, p = .63]). Compared with NIBS alone, the combination treatment had a significantly greater effect in alleviating depressive symptoms ([SMD = - 0.84, 95%CI (- 1.25, - 0.42), I-2 = 0%, p = .93]). However, our results suggested that the pooled effect size of ameliorating depression of NIBS plus psychosocial intervention had no significant difference compared with the combination of sham NIBS [SMD = - 0.12, 95%CI (- 0.31, 0.07), I-2 = 0%, p = .60] and psychosocial intervention alone [SMD = - 0.97, 95%CI (- 2.32, 0.38), I-2 = 72%, p = .01]. Conclusion NIBS when combined with psychosocial intervention has a significant positive effect in alleviating moderately to severely depressive symptoms. Further well-designed studies of NIBS combined with psychosocial intervention on depression should be carried out to consolidate the conclusions and explore the in-depth underlying mechanism.

Automated summary

This review examines the efficacy and safety of non-invasive brain stimulation (NIBS) combined with psychosocial intervention for depressive symptoms. The results suggest that NIBS combined with psychosocial therapy has a positive effect on moderate to severe depression, but minimal to mild depression may not significantly improve. Compared to NIBS alone, the combination treatment shows a significantly greater effect in alleviating depressive symptoms. However, there is no significant difference in the pooled effect size between NIBS plus psychosocial intervention and the combination of sham NIBS and psychosocial intervention alone.