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Recent systematic review and meta-analysis of TMS vs ECT in MDD

25 Apr 2014 6:36 AM | Armida Mucci (Administrator)
 2014 Jun 3;51C:181-189. doi: 10.1016/j.pnpbp.2014.02.004. Epub 2014 Feb 18.

Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: A systematic review and meta-analysis.

Abstract

Electroconvulsive therapy (ECT) is the most effective treatment of depression. During the last decades repetitive transcranial magnetic stimulation (rTMS), an alternative method using electric stimulation of the brain, has revealed possible alternative to ECT in the treatment of depression. There are some clinical trials comparing their efficacies and safeties but without clear conclusions, mainly due to their small sample sizes. In the present study, a meta-analysis had been carried out to gain statistical power. Outcomes were response, remission, acceptability and cognitive effects in depression. Following a comprehensive literature search that included both English and Chinese language databases, we identified all randomized controlled trials that directly compared rTMS and ECT for major depression. 10 articles (9 trials) with a total of 425 patients were identified. Methodological quality, heterogeneity, sensitivity and publication bias were systematically evaluated. ECT was superior to high frequency rTMS in terms of response (64.4% vs. 48.7%, RR=1.41, p=0.03), remission (52.9% vs. 33.6%, RR=1.38, p=0.006) while discontinuation was not significantly different between the two treatments (8.3% vs. 9.4%, RR=1.11, p=0.80). According to the subgroup analysis, the superiority of ECT was more apparent in those with psychotic depression, while high frequency rTMS was as effective as ECT in those with non-psychotic depression. The same results were obtained in the comparison of ECT with low frequency rTMS. ECT had a non-significant advantage over high frequency rTMS on the overall improvement in HAMD scores (p=0.11). There was insufficient data on medium or long term efficacy. Both rTMS and ECT were well tolerated with only minor side effects reported. Results based on 3 studies suggested that specific cognitive domains such as visual memory and verbal fluency were more impaired in patients receiving ECT. In conclusion, ECT seemed more effective than and at least as acceptable as rTMS in the short term, especially in the presence of psychotic depression. This review identified the lack of good quality trials comparing the long-term outcome and cognitive effects of rTMS and ECT, especially using approaches to optimize stimulus delivery and reduce clinical heterogeneity.

Comments

  • 25 Apr 2014 6:47 AM | Armida Mucci (Administrator)
    Electrophysiology has a major role in treatment of psychiatric disorders with two treatments already approved by FDA in the treatment of MDD: ECT and rTMS. The less-invasive rTMS will probably replace ECT in the treatment of MDD. This meta-analysis provide level I evidence of comparable efficacy. At the same time the lack of good quality data is stressed
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    • 13 Jul 2014 11:02 PM | Anonymous
      Perhaps another level of consideration in both ECT and rTMS is utilization of EEG/qEEG for personalized intervention, and a comparison of outcomes for individuals with such specified treatment. Another question might explore how different types of ECT (uni or cross-hemisphere) would compare to rTMS outcomes.
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