Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Q1 Medicine
Ontario Health Technology Assessment Series Pub Date : 2016-03-01 eCollection Date: 2016-01-01
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引用次数: 0

Abstract

Background: To date, several randomized controlled trials (RCTs) have shown the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression.

Objective: This analysis examined the antidepressant efficacy of rTMS in patients with treatment-resistant unipolar depression.

Methods: A literature search was performed for RCTs published from January 1, 1994, to November 20, 2014. The search was updated on March 1, 2015. Two independent reviewers evaluated the abstracts for inclusion, reviewed full texts of eligible studies, and abstracted data. Meta-analyses were conducted to obtain summary estimates. The primary outcome was changes in depression scores measured by the Hamilton Rating Scale for Depression (HRSD), and we considered, a priori, the mean difference of 3.5 points to be a clinically important treatment effect. Remission and response to the treatment were secondary outcomes, and we calculated number needed to treat on the basis of these outcomes. We examined the possibility of publication bias by constructing funnel plots and by Begg's and Egger's tests. A meta-regression was undertaken to examine the effect of specific rTMS technical parameters on the treatment effects.

Results: Twenty-three RCTs compared rTMS with sham, and six RCTs compared rTMS with electroconvulsive therapy (ECT). Trials of rTMS versus sham showed a statistically significant improvement in depression scores with rTMS (weighted mean difference [WMD] 2.31, 95% CI 1.19-3.43; P < .001). This improvement was smaller than the pre-specified clinically important treatment effect. There was a 10% absolute difference between rTMS and sham in the rates of remission or response. This translates to a number needed to treat of 10. Risk ratios for remission and response were 2.20 (95% CI 1.44-3.38, P = .001 and 1.72 [95% CI], 1.13-2.62, P = .01), respectively, favouring rTMS. No publication bias was detected. Trials of rTMS versus ECT showed a statistically and clinically significant difference between rTMS and ECT in favour of ECT (WMD 5.97, 95% CI 0.94-11.0, P = .02). Risk ratios for remission and response were 1.44 (95% CI 0.64-3.23, P = .38) and 1.72 (95% CI 0.95-3.11, P = .07), respectively, favouring ECT.

Conclusions: Overall, the body of evidence favoured ECT for treatment of patients who are treatment-resistant. Repetitive transcranial magnetic stimulation had a small short-term effect for improving depression in comparison with sham, but follow-up studies did not show that the small effect will continue for longer periods.

Abstract Image

Abstract Image

重复经颅磁刺激治疗难治性抑郁症:随机对照试验的系统回顾和荟萃分析。
背景:迄今为止,几项随机对照试验(rct)已经显示了重复经颅磁刺激(rTMS)治疗重度抑郁症的疗效。目的:探讨rTMS对难治性单极抑郁症患者的抗抑郁疗效。方法:检索1994年1月1日至2014年11月20日发表的rct文献。搜索于2015年3月1日更新。两名独立审稿人评估摘要是否纳入,审查符合条件的研究的全文,并摘录数据。进行荟萃分析以获得概要估计。主要结果是汉密尔顿抑郁量表(HRSD)测量的抑郁评分的变化,我们先验地认为3.5分的平均差异是临床重要的治疗效果。缓解和对治疗的反应是次要结果,我们根据这些结果计算需要治疗的人数。我们通过构建漏斗图和Begg’s和Egger’s检验来检验发表偏倚的可能性。采用meta-regression来检验特定rTMS技术参数对治疗效果的影响。结果:23项随机对照试验比较了rTMS与假手术,6项随机对照试验比较了rTMS与电休克治疗(ECT)。rTMS与sham的试验显示,rTMS在抑郁评分上有统计学意义的改善(加权平均差[WMD] 2.31, 95% CI 1.19-3.43;P < 0.001)。这种改善小于预先指定的临床重要治疗效果。rTMS和sham在缓解或反应率上有10%的绝对差异。这意味着需要一个数字来处理10。缓解和缓解的风险比分别为2.20 (95% CI 1.44-3.38, P = 0.001)和1.72 (95% CI 1.13-2.62, P = 0.01), rTMS更有利。未发现发表偏倚。rTMS与ECT的试验显示,rTMS与ECT在统计学和临床上均有显著差异(WMD为5.97,95% CI为0.94-11.0,P = 0.02)。缓解和反应的风险比分别为1.44 (95% CI 0.64-3.23, P = 0.38)和1.72 (95% CI 0.95-3.11, P = 0.07),有利于ECT。结论:总的来说,有大量证据支持电痉挛疗法治疗难治性患者。与假手术相比,反复经颅磁刺激在改善抑郁方面有短期的小效果,但后续研究并未显示这种小效果会持续更长时间。
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
Ontario Health Technology Assessment Series
Ontario Health Technology Assessment Series Medicine-Medicine (miscellaneous)
CiteScore
4.60
自引率
0.00%
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0
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