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), I² = 73%, p <.01]), but did not significantly improve minimal to mild depression ([SMD = − 0.12, 95%CI (− 0.42, 0.18), I² = 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), I² = 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), I² = 0%, p =.60] and psychosocial intervention alone [SMD = − 0.97, 95%CI (− 2.32, 0.38), I² = 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.