Efficacy of individualized noninvasive brain stimulation targets in treating psychiatric disorders: A network meta-analysis.

BACKGROUND

Noninvasive brain stimulation (NIBS) techniques have gained increasing attention in psychiatric research and treatment. Target selection for NIBS is becoming increasingly individualized based on brain morphology or function; however, the extent to which individualized targeting improves treatment outcomes in psychiatric disorders remains a matter of debate.

METHODS

We systematically searched PubMed, Scopus, Web of Science, PsycINFO, ProQuest and Embase published up to April 30, 2024, comparing individualized NIBS targets, standardized group-based targets, and sham stimulation in psychiatric populations. A network meta-analysis was conducted to compare the effectiveness of these approaches across different psychiatric disorders.

RESULTS

A total of 35 studies comprising 1,651 patients were included. Surface under the cumulative ranking (SUCRA) plot showed that individualized targeting ranked highest among the three approaches; however, the difference between individualized and group-based methods was not statistically significant (Mean Difference (MD) = -0.045; 95% CI: -0.244 to 0.333; p = 0.310). Subgroup analysis further categorized individualized methods into PET-, MRI-, fMRI-, and EEG-guided approaches. PET-guided targeting demonstrated significant superiority compared to both sham and group-based targets (MD = -0.744; 95% CI: -1.450 to -0.037; p = 0.039). Disorder-specific analyses revealed varied results in the forest map (schizophrenia: p < 0.01; OCD: p = 0.11; MDD: p = 0.22; addiction: p < 0.05).

CONCLUSIONS

There is a growing trend suggesting that individualized NIBS approaches may be more effective than standardized protocols. However, further validation, especially through high-quality, large-sample randomized control trials focused on PET-guided targeting is needed. From a clinical perspective, structural MRI provides a practical option for anatomical targeting, while EEG and fMRI offer promising, cost-effective alternatives for capturing functional dynamics. Future research should prioritize long-term follow-up studies and explore clinically feasible individualized strategies to advance precision neuromodulation in psychiatric care.