Efficacy and Safety of Neuromodulation Techniques in Depression Treatment: A Systematic Review and Meta-Analysis.

Background: Depression, particularly major depressive disorder, is a leading cause of disability, with limited diagnostic tools based on objective biomarkers. Advances in neurostimulation techniques, such as intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS), show promise in improving treatment outcomes. However, their comparative efficacy and safety remain unclear. Methods: A comprehensive literature search was conducted in databases (PubMed, Embase, Wiley, Web of Science, China National Knowledge Infrastructure (CNKI) database, Wanfang, and VIP) up to September 3, 2024. Data from eligible randomized controlled trials were pooled for meta-analysis, comparing iTBS and rTMS on remission and response rates, as well as adverse effects, using RevMan software. Sensitivity analyses were performed. Results: This meta-analysis included 10 studies. No significant difference was found between iTBS and rTMS in remission (OR=1.01, 95% CI: 0.72-1.42, P=.03) or response rates (OR=1.02, 95% CI: 0.76-1.35, P=.91). The incidence of adverse effects was similar (OR=1.17, 95% CI: 0.83-1.66, P=.38). Compared to sham stimulation, rTMS showed significantly higher remission (OR=4.84, 95% CI: 2.66-8.80, P < .001) and response rates (OR=3.92, 95% CI: 2.08-7.37, P < .001). Conclusion: Both iTBS and rTMS have similar efficacy and safety. Further validation of multimodal neuroimaging biomarkers is needed to enhance personalized treatment strategies.