Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials

Abstract

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

The evidence is in: Repetitive transcranial magnetic stimulation is an effective, safe and well-tolerated treatment for patients with major depressive disorder

“…The research evidence supporting its efficacy has been summarised in numerous meta-analyses and subsequently in umbrella reviews and network meta-analyses. Individual meta-analyses and the recent umbrella review (Razza et al, 2020) have clearly confirmed that rTMS is an effective treatment for patients with MDD and is safe and well tolerated. Network meta-analysis have confirmed that there are several forms of rTMS that are effective and importantly that it has comparable, if not superior, efficacy when compared to other interventions for patients with TRD.…”

“…A recent umbrella review has also evaluated the evidence for the efficacy of rTMS using the rigorous GRADE approach to assess the quality of evidence across existing meta-analysis (Razza et al, 2020). ‘High-quality evidence’ was found to support the efficacy of high-frequency left-sided rTMS and sequential bilateral rTMS.…”

Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again

“…As has been presented recently in this journal (Fitzgerald et al, 2021a) and described extensively elsewhere (e.g. Brunoni et al, 2017; Papadimitropoulou et al, 2017; Razza et al, 2020), these statements are inaccurate (see Table 1). In fact, there already exists a substantive evidence base supporting the use of rTMS in the treatment of depression that extends from multisite clinical trials to multiple meta-analyses, network meta-analyses, umbrella reviews and large-scale real-world treatment outcome data (Fitzgerald et al, 2021a).…”

Advancing the use of non-invasive brain stimulation through systematic data review

“…This is why a recent publication by Razza et al 1 is of importance. Clearly, many people in the psychiatric community have been unconvinced by the barrage of clinical trials, larger multisite trials, and numerous meta-analyses (e.g., Berlim et al 2 and Mutz et al 3 ) and comparative analyses showing the relative efficacy of rTMS compared to other treatment options for depression.…”