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Abstract: bipolar disorder is a chronic psychiatric disorder with severe disease burden, especially as induced by bipolar depression. Noninvasive brain stimulation (NIBS) has shown antidepressant potential, but its adjunctive benefit when combined with pharmacotherapy remains unclear. This meta-analysis evaluates the efficacy of NIBS combined with medication. Methods: A comprehensive search was conducted across PubMed, Embase, and the Web of Science, including studies up to July 31, 2024. Randomized controlled trials comparing NIBS plus medication with medication monotherapy or sham stimulation were included. The primary outcome evaluated was the change in depressive symptoms; secondary outcomes included response rate, remission rate, dropout rate, and cognitive changes. Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity. Results: Seventeen randomized controlled trials (RCTs) involving 748 screened records were included, comprising 11 transcranial magnetic stimulation (TMS) trials and six transcranial direct current stimulation (tDCS) trials. Compared with pharmacotherapy alone, NIBS combined with medication was linked to greater reductions in depressive symptoms (SMD=?0.69). Both TMS and tDCS were associated with improvements in depressive symptoms and response rates, whereas a statistically significant association with remission was observed only for TMS. No significant differences were observed in dropout rates or cognitive outcomes. Meta-regression analyses did not identify consistent associations between treatment effects and demographic or stimulation-related variables, although an exploratory potential association between tDCS current intensity and symptom improvement was observed. Conclusions: NIBS combined with medication may offer additional benefit over pharmacotherapy alone for bipolar depression. Nevertheless, substantial heterogeneity and the limited number of available trials warrant cautious interpretation. Further well-designed randomized controlled trials are needed to confirm these findings and to clarify the role of stimulation parameters.