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P261 Clinical outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) in the treatment of major depression. An overview of findings from meta-analyses.
- Source :
-
Clinical Neurophysiology . Mar2017, Vol. 128 Issue 3, pe140-e140. 1p. - Publication Year :
- 2017
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Abstract
- Background Meta-analyses comparing the short-term clinical outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) in major depression produced conflicting results. The aim of the current study was to summarise the results of these meta-analyses. Methods A systematic literature search of PubMed and PsycInfo (any time – 13.01.2016) identified k = 4 systematic reviews (published in 2010–2014) comparing the clinical outcomes of ECT and HF-rTMS in major depression using quantitative meta-analysis. The short-term outcomes were the standardised mean change scores (baseline – last stimulation) on depression scales and odds or risk ratios of response, remission, and acceptability (dropout) rates. Since different meta-analytical approaches were used, we have pooled the effects using random-effects model with inverse-variance weights based on data shown in reviews. Results The k = 4 reviews included different combinations of k = 8 open-label or single-blind, randomised primary studies with major depression patients. Most studies utilised right unilateral ECT (2.5 times the seizure threshold, 6–12 sessions) and HF-rTMS (10–20 Hz) of the left dorsolateral prefrontal cortex (90–110% of the resting motor threshold, 10–20 sessions). The pooled weighted effects favoured ECT over HF-rTMS in terms of reduction in depression severity (change scores in k = 2 reviews), while response and acceptability rates of both methods were similar (in k = 2 and k = 3 reviews respectively), and remission rates were inconsistent in k = 3 reviews (possibly due to heterogeneous definitions of remission). The individual study effect sizes favoured ECT over HF-rTMS in terms of reduction in depression severity and remission rate in studies with psychotic major depression patients. Conclusion Uniform meta-analytical approaches suggest that ECT might be clinically superior to HF-rTMS in psychotic major depression, while the clinical outcomes tend to be similar in non-psychotic major depression in the short-term treatment. Future blinded randomised trials are required to compare the long-term clinical outcomes of both methods in clinically-homogeneous samples with major depression. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 13882457
- Volume :
- 128
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- Clinical Neurophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 121276182
- Full Text :
- https://doi.org/10.1016/j.clinph.2016.10.374