Comparing different non-invasive brain stimulation interventions for bipolar depression treatment: A network meta-analysis of randomized controlled trials

Chih-Wei Hsu; Po-Han Chou; Andre R Brunoni; Kuo-Chuan Hung; Ping-Tao Tseng; Chih-Sung Liang; Andre F Carvalho; Eduard Vieta; Yu-Kang Tu; Pao-Yen Lin; Che-Sheng Chu; Tien-Wei Hsu; Yang-Chieh Brian Chen; Cheng-Ta Li

doi:10.1016/j.neubiorev.2023.105483

Comparing different non-invasive brain stimulation interventions for bipolar depression treatment: A network meta-analysis of randomized controlled trials

Neurosci Biobehav Rev. 2024 Jan:156:105483. doi: 10.1016/j.neubiorev.2023.105483. Epub 2023 Dec 5.

Authors

Affiliations

¹ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Dr. Chou's Mental Health Clinic; Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.
³ Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil; Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil.
⁴ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁵ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
⁶ Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
⁷ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
⁸ Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
⁹ Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹¹ Department of Psychiatry, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychiatry, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
¹² Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: brianthechen@gmail.com.
¹³ Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: on5083@msn.com.

PMID: 38056187
DOI: 10.1016/j.neubiorev.2023.105483

Abstract

Non-invasive brain stimulation (NIBS) is a promising treatment for bipolar depression. We systematically searched for randomized controlled trials on NIBS for treating bipolar depression (INPLASY No: 202340019). Eighteen articles (N = 617) were eligible for network meta-analysis. Effect sizes were reported as standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). Anodal transcranial direct current stimulation over F3 plus cathodal transcranial direct current stimulation over F4 (a-tDCS-F3 +c-tDCS-F4; SMD = -1.18, 95%CIs = -1.66 to -0.69, N = 77), high-definition tDCS over F3 (HD-tDCS-F3; -1.17, -2.00 to -0.35, 25), high frequency deep transcranial magnetic stimulation (HF-dTMS; -0.81, -1.62 to -0.001, 25), and high frequency repetitive TMS over F3 plus low frequency repetitive TMS over F4 (HF-rTMS-F3 +LF-rTMS-F4; -0.77, -1.43 to -0.11, 38) significantly improved depressive symptoms compared to sham controls. Only a-tDCS-F3 +c-tDCS-F4 (OR = 4.53, 95%CIs = 1.51-13.65) and HF-rTMS-F3 +LF-rTMS-F4 (4.69, 1.02-21.56) showed higher response rates. No active NIBS interventions exhibited significant differences in dropout or side effect rates, compared with sham controls.

Keywords: Antidepressant; Bipolar disorder; Theta burst stimulation; Transcranial electrical stimulation.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Bipolar Disorder* / etiology
Bipolar Disorder* / therapy
Brain / physiology
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Transcranial Direct Current Stimulation*
Transcranial Magnetic Stimulation