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Nonsurgical Brain Stimulation Beneficial in Major Depressive Episodes

Ten of 18 reviewed treatment strategies linked to higher response versus sham therapy

THURSDAY, March 28, 2019 (HealthDay News) — Nonsurgical brain stimulation techniques seem effective for acute treatment of major depressive episodes in adults, according to a review published online March 27 in The BMJ.

Julian Mutz, from King’s College London, and colleagues conducted a systematic review to estimate the comparative clinical efficacy and acceptability of nonsurgical brain stimulation for acute treatment of major depressive episodes in adults. Data were included for 113 trials that randomly assigned 6,750 patients with major depressive disorder or bipolar depression.

The researchers found that evidence in 94 of the trials was of low or unclear risk for bias; there was considerable variation in the precision of summary estimates. Ten of the 18 treatment strategies correlated with higher response versus sham therapy: bitemporal electroconvulsive therapy (ECT; summary odds ratio, 8.91), high-dose right unilateral ECT (7.27), priming transcranial magnetic stimulation (TMS; 6.02), magnetic seizure therapy (5.55), bilateral repetitive TMS (4.92), bilateral theta burst stimulation (4.44), low-frequency right repetitive TMS (3.65), intermittent theta burst stimulation (3.20), high-frequency left repetitive TMS (3.17), and transcranial direct current stimulation (2.65). Compared with another active treatment, bitemporal ECT and high-dose right unilateral ECT correlated with increased response.

“This review highlights important research priorities in the specialty of brain stimulation — for example, the need to conduct further well designed randomized controlled trials comparing novel treatment modalities, and sham controlled trials investigating magnetic seizure therapy,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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