Researchers who reviewed 113 prior studies of non-surgical brain stimulation for major depressive episodes found that all the brain stimulation treatments were more effective than ‘sham’ (or fake) therapy.
The detailed review of previous research was published in the BMJ (British Medical Journal).
The team of researchers looked at 113 clinical trials involving 6,750 patients who had major depressive disorder or bipolar depression.
The brain stimulation treatments reviewed included:
- TMS transcranial magnetic stimulation
- ECT electroconvulsive therapy
- TDCS transcranial direct current stimulation (transcranial electrical stimulation)
- Magnetic seizure therapy
‘Sham treatment’ was used for comparison – this is where patients received a simulated form of treatment but with no medical impact.
All the brain stimulation treatments were found to be more effective than sham therapy.
The report’s conclusions summarised:
“These findings provide evidence for the consideration of non-surgical brain stimulation techniques as alternative or add-on treatments for adults with major depressive episodes. These findings also highlight important research priorities in the specialty of brain stimulation, such as the need for further well designed randomised controlled trials comparing novel treatments, and sham controlled trials investigating magnetic seizure therapy.”
The report draws out a number of key policy implications of its findings including:
- “We anticipate our findings to have implications for clinical decision making and research in that they will inform clinicians, patients, and healthcare providers on the relative merits of multiple non-surgical brain stimulation techniques”
- “Personalising clinically effective treatments without major risk of adverse effects for treatment-resistant depression remains an unmet need. “
- “Although guidelines do support the use of non-surgical brain stimulation, these treatments tend to be applied in clinical practice too little and too late.”
- “Although ECT is sometimes considered for severe forms of depression, our review suggests that other treatment protocols with robust evidence and more precision in treatment effect estimates (high frequency left rTMS, low-frequency right rTMS, bilateral rTMS, and tDCS) should be prioritised over novel protocols with a more limited evidence base. “
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