Psychiatry · 3 h ago
Network meta-analysis compares brain stimulation treatments for late-life depression
A systematic review and network meta-analysis included 25 randomized trials with 1,344 adults aged 60 years or older with major depressive disorder. Bilateral electroconvulsive therapy and 10-Hz left-sided repetitive transcranial magnetic stimulation showed the most consistent benefits over sham, with moderate-certainty evidence.
- Review included 25 trials and 1,344 participants aged 60 or older.
- BL-ECT and 10-Hz left-sided rTMS outperformed sham.
- Evidence was moderate certainty; symptom-network inconsistency was detected.
- Other highly ranked modalities had sparse supporting data.
Late-life depression can be difficult to treat, and non-invasive brain stimulation (NIBS) is among the interventions studied. This systematic review and network meta-analysis evaluated randomized controlled trials of NIBS in adults aged 60 years or older with major depressive disorder. Searches of PubMed, EMBASE and the Cochrane Library covered records through June 2025. The review included 25 trials, 1,344 participants and 15 stimulation modalities; outcomes included change in depressive symptoms, response and remission. Evidence certainty was assessed using GRADE.
Bilateral electroconvulsive therapy (BL-ECT) and 10-Hz repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex (rTMS-10Hz-F3) consistently outperformed sham across efficacy outcomes. For symptom change, reported standardized mean differences were 1.13 (95% CI 0.37–1.90) for BL-ECT and 0.42 (95% CI 0.02–0.81) for rTMS-10Hz-F3. Both had moderate-certainty evidence. The authors detected inconsistency in the symptom-severity network; other highly ranked modalities were supported by sparse data and warrant cautious interpretation.
The findings compare treatments across trials but do not establish that either approach should be preferred for an individual patient. The source provides no details on adverse effects or comparative acceptability. The review was registered with PROSPERO (CRD42024628560).
In practice
For adults aged 60 years or older with major depressive disorder, this network meta-analysis found that bilateral electroconvulsive therapy and 10-Hz repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex consistently outperformed sham across efficacy outcomes. The evidence for these comparisons was rated moderate certainty, but inconsistency was detected in the symptom-severity network, and other highly ranked modalities had sparse data. These findings may inform consideration of treatment options, but the review alone does not establish a preferred approach for individual patients or justify a change in practice.
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Acta Psychiatrica Scandinavica: Efficacy of Non‐Invasive Brain Stimulation on the Treatment of Late Life Depression: A Systematic Review and Network Meta‐Analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.