To assess the relative efficacy of various Non-Invasive Brain Stimulation Techniques used in the treatment of Unipolar Depression.

A thorough systematic search was conducted in the databases PubMed/MEDLINE, EMBASE, Scopus, Cochrane and ClinicalTrials.gov to identify RCTs focusing on NIBS interventions used in unipolar depression. The search included trials from the earliest available date up to July 2024.  A Network meta-analysis was conducted to evaluate the efficacy of NIBS interventions used in treating unipolar Depression based on three outcomes: HAMD, BDI and the MADRS. Data were analysed using the R language for statistical computing and the ? netmeta ? package.

 The pairwise treatment effects were calculated using the SMD as the effect measure. The network meta-analysis considered both direct and indirect comparisons. Subsequent analyses included ranking treatments based on their effectiveness, exploring direct versus indirect evidence through split network meta-analysis, and pairwise meta-analysis comparisons.

Our NMA evaluated multiple treatments across the BDI, MADRS, and HAMD with sample sizes of 1426, 2082, and 2479 respectively. ECT was most effective in reducing BDI scores (mean difference: -1.39, CI: -1.95 to -0.83), SNT led in MADRS reductions (mean difference: -1.76, CI: -2.83 to -0.70), and PET-guided rTMS showed the largest effect on HAMD (mean difference: -3.52, CI: -6.59 to -0.441).

These findings underscore the efficacy of specific interventions like ECT for BDI, SNT for MADRS, and PET-guided rTMS for HAMD, suggesting that treatment approaches should be tailored to the depressive scale and patient symptom profiles.