Comparative efficacy and acceptability of neuromodulation procedures in the treatment of treatment-resistant depression: a network meta-analysis of randomized controlled trials

Hao Li; Liqian Cui; Jinbiao Li; Yueheng Liu; Yue Chen

doi:10.1016/j.jad.2021.03.019

Comparative efficacy and acceptability of neuromodulation procedures in the treatment of treatment-resistant depression: a network meta-analysis of randomized controlled trials

J Affect Disord. 2021 May 15:287:115-124. doi: 10.1016/j.jad.2021.03.019. Epub 2021 Mar 11.

Authors

Hao Li¹, Liqian Cui², Jinbiao Li¹, Yueheng Liu³, Yue Chen⁴

Affiliations

¹ Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
² Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China. Electronic address: [email protected].
³ Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China.
⁴ The eighth Hospital Affiliated, Sun Yat-sen University, Shenzhen, 518101, Guangdong, China.

PMID: 33780827
DOI: 10.1016/j.jad.2021.03.019

Abstract

Background: Nearly half of the patients with depression experience suboptimal benefits from antidepressants. Neuromodulation therapies, a kind of technology that can regulate neuronal firing activity by electrical or magnetic stimulation, were introduced to improve this situation. However, the results from clinical trials have been inconsistent.

Methods: We followed the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to perform this network meta-analysis (NMA). The results were evaluated by relative risk (RR) for the response, remission, and discontinuation rates.

Results: In total, 49 trials with 2,941 patients were included in this study. Bilateral theta burst stimulation (TBS, RR 5.00, 95% CI 1.11-22.44), priming transcranial magnetic stimulation (pTMS, RR 2.97, 95% CI 1.20-7.39), low-frequency right repetitive transcranial magnetic stimulation (TMS) (LFR-rTMS, RR 2.62, 95% CI 1.56-4.39), high-frequency left repetitive TMS (HFL-rTMS, RR 2.18, 95% CI 1.52-3.13), and bilateral repetitive TMS (BL-rTMS, RR 3.08, 95% CI 1.78-5.31) were demonstrated to have higher response rates than sham control. BL-rTMS (RR 3.12, 95% CI 1.06-9.09) was found to have a higher response rate than deep brain stimulation in this NMA. All measures had the non-inferiority acceptability than the sham-control. BL-rTMS was more acceptable than bitemporal ECT (BT-ECT, RR 0.18, 95% CI 0.03-0.89), while pTMS was more acceptable than BT-ECT (RR 0.08, 95% CI 0.01-0.55), HFL-rTMS (RR 0.34, 95% CI 0.12-0.93), and deep TMS (RR 0.15, 95% CI 0.02-0.96).

Conclusion: Besides electroconvulsive therapy (ECT), rTMS, priming TMS, and bilateral TBS proved effective for patients with treatment-resistant depression (TRD). BL-rTMS showed high efficacy and acceptability, and bilateral TBS had the potential to be the most efficacious neuromodulation measures.

Keywords: Neuromodulation procedures; depression; network meta-analysis; randomized clinical trials; treatment-resistant depression.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Depression*
Depressive Disorder, Major* / therapy
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Transcranial Magnetic Stimulation
Treatment Outcome