Efficacy of Non‐Invasive Brain Stimulation on the Treatment of Late Life Depression: A Systematic Review and Network Meta‐Analysis

Objective This network meta‐analysis (NMA) aimed to evaluate the comparative efficacy of non‐invasive brain stimulation (NIBS) interventions for late‐life depression (LLD), with treatment rankings provided as a secondary outcome. Methods We conducted a systematic review and NMA of randomized controlled trials (RCTs) assessing NIBS for major depressive disorder in adults aged ≥ 60 years. Comprehensive searches of PubMed, EMBASE, and Cochrane Library were performed up to June 2025. Two reviewers independently selected studies, extracted data, and assessed quality using the Cochrane Risk of Bias tool. A random‐effects NMA was implemented using the netmeta package in R. Certainty of evidence was evaluated using the GRADE framework. Primary outcomes included changes in depressive symptoms, measured by the standard mean difference (SMD). Secondary outcomes included response rates and remission rates. Results Twenty‐five RCTs involving 1344 participants and 15 NIBS modalities were included. Bilateral electroconvulsive therapy (BL‐ECT; SMD = 1.13, 95% CI 0.37–1.90) and high‐frequency repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex (rTMS‐10Hz‐F3; SMD = 0.42, 95% CI 0.02–0.81) consistently outperformed sham across all efficacy outcomes. Both interventions formed closed loops of the network geometry, enabling formal assessment of agreement between direct and indirect evidence. Although inconsistency was detected in the symptom severity network, both interventions demonstrated consistent benefits across efficacy outcomes and retained moderate‐certainty evidence. Conclusion BL‐ECT and rTMS‐10Hz‐F3 emerged as the most consistently effective NIBS treatments for LLD, supported by moderate‐certainty evidence. Other highly‐ranked modalities require cautious interpretation due to sparse data. Registration: PROSPERO (CRD42024628560).