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

Laís B Razza¹, Leonardo Afonso Dos Santos¹, Lucas Borrione¹, Helena Bellini^{1

2}, Luis C Branco³, Eric Cretaz⁴, Dante Duarte^{3

5}, Ygor Ferrão⁶, Ricardo Galhardoni^{7

8}, João Quevedo^{9

10

11

12}, Marcel Simis¹³, Felipe Fregni¹⁴, Christoph U Correll^{15

16

17}, Frank Padberg¹⁸, Alisson Trevizol^{19

20}, Zafiris J Daskalakis^{20

21}, Andre F Carvalho^{20

21}, Marco Solmi²², André R Brunoni^{1

23

24

25}

Affiliations

¹ Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
² Laboratório de Neuroimagem em Psiquiatria (LIM21), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
³ Neuromodulation and Clinical Research Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Serviço de Eletroconvulsoterapia, Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
⁵ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁶ Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
⁷ Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.
⁸ Centro de Dor (LIM-62), Departamento de Neurologia, HCFMUSP, São Paulo, SP, Brazil.
⁹ Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
¹⁰ Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, TX, USA.
¹¹ Neuroscience Graduate Program, The University of Texas, MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
¹² Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.
¹³ Instituto de Medicina Física e Reabilitação, HCFMUSP, São Paulo, SP, Brazil.
¹⁴ Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
¹⁵ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
¹⁶ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁷ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁸ Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany.
¹⁹ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
²⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
²¹ Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
²² Dipartimento di Neuroscienze, Università Degli Studi Di Padova, Padova, Italy.
²³ HCFMUSP, São Paulo, SP, Brazil.
²⁴ Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
²⁵ Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.

PMID: 33111776
PMCID: PMC8555652
DOI: 10.1590/1516-4446-2020-1169

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

Laís B Razza et al. Braz J Psychiatry. 2021 Sep-Oct.

. 2021 Sep-Oct;43(5):514-524.

doi: 10.1590/1516-4446-2020-1169.

Authors

Affiliations

¹ Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
² Laboratório de Neuroimagem em Psiquiatria (LIM21), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
³ Neuromodulation and Clinical Research Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Serviço de Eletroconvulsoterapia, Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
⁵ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁶ Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
⁷ Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.
⁸ Centro de Dor (LIM-62), Departamento de Neurologia, HCFMUSP, São Paulo, SP, Brazil.
⁹ Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
¹⁰ Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, TX, USA.
¹¹ Neuroscience Graduate Program, The University of Texas, MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
¹² Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.
¹³ Instituto de Medicina Física e Reabilitação, HCFMUSP, São Paulo, SP, Brazil.
¹⁴ Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
¹⁵ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
¹⁶ Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁷ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁸ Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany.
¹⁹ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
²⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
²¹ Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
²² Dipartimento di Neuroscienze, Università Degli Studi Di Padova, Padova, Italy.
²³ HCFMUSP, São Paulo, SP, Brazil.
²⁴ Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.
²⁵ Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, HCFMUSP, São Paulo, SP, Brazil.

PMID: 33111776
PMCID: PMC8555652
DOI: 10.1590/1516-4446-2020-1169

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.

PubMed Disclaimer

Conflict of interest statement

CUC has been a consultant and/or advisor to or has received honoraria from Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has provided expert testimony for Janssen and Otsuka; has served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva; has received grant support from Janssen and Takeda; has received royalties from UpToDate; and is a stock option holder of LB Pharma. FP is a member of the European Scientific Advisory Board of Brainsway Inc., Jerusalem, Israel; has received speaker’s honoraria from Mag & More GmbH and the neuroCare Group; his lab has received support with equipment from neuroConn GmbH, Ilmenau, Germany, Mag & More GmbH, and Brainsway Inc., Jerusalem, Israel. ARB is chief medical advisor of Flow™ and has small equity in the company. The other authors report no conflicts of interest.

Figures

**Figure 1. Flowchart of the included meta-analyses. MA = meta-analysis; RCTs = randomized controlled trials; SR = systematic-review.**

See this image and copyright information in PMC

References

1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990--2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59. - PMC - PubMed
1. Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry. 2016;61:540–60. - PMC - PubMed
1. Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 2. Psychological treatments. Can J Psychiatry. 2016;61:524–39. - PMC - PubMed
1. Rush AJ, Trivedi MH, Wisniewski SR, Stewart JW, Nierenberg AA, Thase ME, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231–42. - PubMed
1. Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:1462–70. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical