EFFICACY AND ACCEPTABILITY OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) VERSUS ELECTROCONVULSIVE THERAPY (ECT) FOR MAJOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS

Authors

  • Marcelo T. Berlim M.D., M.Sc.,

    Corresponding author
    1. Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
    • Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
    Search for more papers by this author
  • Frederique Van den Eynde M.D., Ph.D.,

    1. Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
    Search for more papers by this author
  • Zafiris J. Daskalakis M.D., Ph.D.

    1. Brain Stimulation Treatment and Research Program, Centre for Addiction and Mental Health and University of Toronto, Ontario, Canada
    Search for more papers by this author

Correspondence to: Marcelo T. Berlim, Douglas Mental Health University Institute, 6875 LaSalle Blvd., FBC-3 Pavilion, Montréal, Québec, H4H 1R3, Canada. E-mail: nrc.douglas@me.com

Abstract

Clinical trials comparing the efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) for treating major depression (MD) have yielded conflicting results. As this may have been the result of limited statistical power, we have carried out this meta-analysis to examine this issue. We searched the literature for randomized trials on head-to-head comparisons between HF-rTMS and ECT from January 1995 through September 2012 using MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and SCOPUS. The main outcome measures were remission rates, pre-post changes in depression ratings, as well as overall dropout rates at study end. We used a random-effects model, Odds Ratios (OR), Number Needed to Treat (NNT), and Hedges’ g effect sizes. Data were obtained from 7 randomized trials, totalling 294 subjects with MD. After an average of 15.2 HF-rTMS and 8.2 ECT sessions, 33.6% (38/113) and 52% (53/102) of subjects were classified as remitters (OR = 0.46; p = 0.04), respectively. The associated NNT for remission was 6 and favoured ECT. Also, reduction of depressive symptomatology was significantly more pronounced in the ECT group (Hedges’ g = −0.93; p = 0.007). No differences on dropout rates for HF-rTMS and ECT groups were found. In conclusion, ECT seems to be more effective than HF-rTMS for treating MD, although they did not differ in terms of dropout rates. Nevertheless, future comparative trials with larger sample sizes and better matching at baseline, longer follow-ups and more intense stimulation protocols are warranted.

Ancillary