Background

Nearly half of the patients with depression experience suboptimal benefits from antidepressants. Neuromodulation therapies, a kind of technology that can regulate neuronal firing activity by electrical or magnetic stimulation, were introduced to improve this situation. However, the results from clinical trials have been inconsistent.

Methods

We followed the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to perform this network meta-analysis (NMA). The results were evaluated by relative risk (RR) for the response, remission, and discontinuation rates.

Results

In total, 49 trials with 2,941 patients were included in this study. Bilateral theta burst stimulation (TBS, RR 5.00, 95% CI 1.11-22.44), priming transcranial magnetic stimulation (pTMS, RR 2.97, 95% CI 1.20-7.39), low-frequency right repetitive transcranial magnetic stimulation (TMS) (LFR-rTMS, RR 2.62, 95% CI 1.56-4.39), high-frequency left repetitive TMS (HFL-rTMS, RR 2.18, 95% CI 1.52-3.13), and bilateral repetitive TMS (BL-rTMS, RR 3.08, 95% CI 1.78-5.31) were demonstrated to have higher response rates than sham control. BL-rTMS (RR 3.12, 95% CI 1.06-9.09) was found to have a higher response rate than deep brain stimulation in this NMA. All measures had the non-inferiority acceptability than the sham-control. BL-rTMS was more acceptable than bitemporal ECT (BT-ECT, RR 0.18, 95% CI 0.03-0.89), while pTMS was more acceptable than BT-ECT (RR 0.08, 95% CI 0.01-0.55), HFL-rTMS (RR 0.34, 95% CI 0.12-0.93), and deep TMS (RR 0.15, 95% CI 0.02-0.96).

Conclusion

Besides electroconvulsive therapy (ECT), rTMS, priming TMS, and bilateral TBS proved effective for patients with treatment-resistant depression (TRD). BL-rTMS showed high efficacy and acceptability, and bilateral TBS had the potential to be the most efficacious neuromodulation measures.

中文翻译：

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神经调节程序在难治性抑郁症治疗中的比较功效和可接受性：随机对照试验的网络荟萃分析

背景

将近一半的抑郁症患者从抗抑郁药中获得的治疗效果欠佳。为了改善这种情况，人们引入了神经调节疗法，该技术可以通过电刺激或磁刺激来调节神经元的放电活动。但是，临床试验的结果不一致。

方法

我们遵循了系统评价和荟萃分析的首选报告项目（PRISMA）语句的扩展，以执行此网络荟萃分析（NMA）。通过响应，缓解和停药率的相对风险（RR）评估结果。

结果

本研究共纳入49项试验，涉及2,941名患者。双边theta爆裂刺激（TBS，RR 5.00，95％CI 1.11-22.44），启动经颅磁刺激（pTMS，RR 2.97，95％CI 1.20-7.39），低频右重复经颅磁刺激（TMS）（LFR- rTMS，RR 2.62、95％CI 1.56-4.39），高频左重复性TMS（HFL-rTMS，RR 2.18、95％CI 1.52-3.13）和双边重复性TMS（BL-rTMS，RR 3.08、95％CI） 1.78-5.31）被证明比假对照组具有更高的反应率。在该NMA中，发现BL-rTMS（RR 3.12，95％CI 1.06-9.09）具有比深部脑刺激更高的响应率。所有措施均具有比假手术对照者更低的接受力。BL-rTMS比双时态ECT（BT-ECT，RR 0.18，95％CI 0.03-0.89）更可接受，而pTMS比BT-ECT（RR 0）更可接受。

结论

除了电惊厥疗法（ECT）之外，rTMS，引发性TMS和双侧TBS被证明对治疗抵抗性抑郁症（TRD）的患者有效。BL-rTMS显示出很高的疗效和可接受性，而双边TBS有望成为最有效的神经调节措施。