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.

中文翻译：

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评估脑电刺激技术在急性重性抑郁发作中的有效性：对随机对照试验荟萃分析的总体审查

电和磁脑刺激技术在抑郁症的急性治疗中呈现出独特的机制和功效。这是对用于管理急性重性抑郁发作的脑刺激技术的随机对照试验的荟萃分析的总体审查。从开始到 2020 年 3 月，在 PubMed/MEDLINE 数据库中进行了系统评价。我们纳入了英语荟萃分析和最随机对照试验，研究任何脑刺激技术与对照对急性抑郁发作成人的影响。评估了连续和二分结果。应用了评估系统评价的衡量工具-2，并使用建议分级评估、制定和评估框架评估了证据的可信度。包括七项荟萃分析（5,615 名患者），为不同形式的脑刺激技术提供了证据。三项荟萃分析被评估为具有高方法学质量，三项为中等，一项为低。高频重复经颅磁刺激 (rTMS)、经颅直流电刺激和双侧 rTMS 的证据质量最高。有强有力的临床研究证据可以指导某些技术的未来临床使用。我们的结果证实了这些技术影响的异质性，表明不同的作用机制会导致不同的疗效特征。和一个低。高频重复经颅磁刺激 (rTMS)、经颅直流电刺激和双侧 rTMS 的证据质量最高。有强有力的临床研究证据可以指导某些技术的未来临床使用。我们的结果证实了这些技术影响的异质性，表明不同的作用机制会导致不同的疗效特征。和一个低。高频重复经颅磁刺激 (rTMS)、经颅直流电刺激和双侧 rTMS 的证据质量最高。有强有力的临床研究证据可以指导某些技术的未来临床使用。我们的结果证实了这些技术影响的异质性，表明不同的作用机制会导致不同的疗效特征。