46. COMPARING THE EFFICACY OF BRAIN STIMULATION THERAPIES FOR LATE-LIFE DEPRESSION: A NETWORK META-ANALYSIS

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry Pub Date : 2025-07-14 DOI:10.1016/j.jagp.2025.04.048

Chemin Lin , Chen-Hsin Yu , Huang-Li Lin , Ying-Chih Cheng

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引用次数: 0

Abstract

Introduction

Late-life depression (LLD) is a common and debilitating condition. Brain stimulation therapies, including electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), offer promising alternatives to traditional treatments. However, their relative efficacy in older adults remains unclear. This meta-analysis aims to provide evidence-based guidance for optimizing brain stimulation approaches in clinical practice.

Methods

A network meta-analysis (NMA) was conducted to compare brain stimulation therapies for LLD. A systematic literature search identified randomized controlled trials (RCTs) evaluating ECT, rTMS, tDCS, and other neuromodulation techniques. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were computed to assess treatment effects on depression severity. A Bayesian NMA estimated relative treatment rankings, and statistical models evaluated heterogeneity and consistency.

Results

This meta-analysis includes 17 studies with 1,056 participants, comparing nine brain stimulation treatments. Compared to sham, all interventions improved depression severity. Bilateral ECT (SMD = 1.14, 95% CI: 0.07–2.21) and mixed ECT (SMD = 1.12, 95% CI: -0.09–2.33) showed the highest efficacy. High-frequency rTMS (20Hz) had a notable effect (SMD = 1.47, 95% CI: 0.35–2.59), while lower-frequency rTMS and tDCS showed more modest improvements.

Conclusions

High-frequency rTMS and ECT, particularly bilateral ECT, appear most effective for LLD. All brain stimulation methods showed benefits, and clinicians should consider availability, tolerability, and patient preference when selecting the optimal treatment.

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46. 比较脑刺激疗法治疗老年抑郁症的疗效：网络荟萃分析

老年抑郁症（LLD）是一种常见的使人衰弱的疾病。脑刺激疗法，包括电痉挛疗法（ECT）、重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS），为传统治疗提供了有希望的替代方案。然而，它们对老年人的相对疗效尚不清楚。本荟萃分析旨在为临床实践中优化脑刺激方法提供循证指导。方法采用网络meta分析（NMA）比较脑刺激治疗LLD的疗效。系统的文献检索确定了随机对照试验（rct）评估ECT， rTMS， tDCS和其他神经调节技术。计算标准化平均差异（SMDs）和95%置信区间（CIs）来评估治疗对抑郁症严重程度的影响。贝叶斯NMA估计相对治疗排名，统计模型评估异质性和一致性。本荟萃分析包括17项研究，1056名参与者，比较了9种脑刺激治疗。与对照组相比，所有干预措施都改善了抑郁症的严重程度。双侧ECT （SMD = 1.14,95% CI: 0.07-2.21）和混合ECT （SMD = 1.12,95% CI: -0.09-2.33）疗效最高。高频rTMS （20Hz）有显著的效果（SMD = 1.47,95% CI: 0.35-2.59），而低频rTMS和tDCS的改善较为温和。结论高频rTMS联合电痉挛治疗LLD，尤其是双侧电痉挛治疗效果最好。所有脑刺激方法都显示出益处，临床医生在选择最佳治疗方法时应考虑可用性、耐受性和患者偏好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

13.00

自引率

4.20%

发文量

381

审稿时长

26 days

期刊介绍： The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.