Maintenance of Noninvasive Brain Stimulation for Preventing Relapse in Depression: A Systematic Review and...

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Research

Background:

• High rates of depression relapse persist after initial treatment.
• Noninvasive brain stimulation is being explored for maintenance therapy to prevent relapse.
• Optimal parameters for maintenance brain stimulation require further investigation.

Purpose of the Study:

• To evaluate the efficacy of maintenance noninvasive brain stimulation in preventing depression relapse.
• To identify optimal treatment parameters for maintenance brain stimulation.
• To compare the effectiveness of different brain stimulation techniques and pharmacotherapy.

Main Methods:

• A meta-analysis adhering to PRISMA guidelines was performed.
• Systematic searches were conducted across major scientific databases up to January 2025.
• Nine randomized controlled trials involving 837 participants were included.

Main Results:

• Electroconvulsive therapy (ECT) combined with pharmacotherapy or repetitive transcranial magnetic stimulation (rTMS) alone significantly reduced depression relapse rates compared to pharmacotherapy alone at 6, 9, and 12 months.
• ECT alone did not demonstrate significant relapse prevention.
• Optimal stimulation parameters, including right unilateral stimulation for ECT with pharmacotherapy and higher frequencies for rTMS, were noted.

Conclusions:

• Maintenance ECT combined with pharmacotherapy or rTMS alone is more effective than pharmacotherapy alone in preventing depression relapse over 6 to 12 months.
• Future research should focus on optimizing treatment regimens and exploring combination therapies.
• Further investigation into other brain stimulation techniques like tDCS and MST is warranted.