Abstract
Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the “gold standard” treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed.
Highlights
Electroconvulsive therapy (ECT) is one of the oldest forms of treatment in psychiatry that is still used today
With respect to the diagnosis, participants in all studies had a current diagnosis of Major Depressive Disorder (MDD)
Most of the participants in the studies were referred due to treatment resistance, which was an actual selection criterion in two of the studies [28, 29]
Summary
A recent systematic review showed “significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs, and ECT versus MAOIs” [1]. This confirmed the findings by the UK ECT Review Group [2] which had found that ECT is an “effective short-term treatment for depression and is probably more effective than drug therapy.”. ECT has been shown to have positive effects in patients suffering from severe depression with psychosis, who saw a remission rate of up to 90%. ECT has been used in a number of other conditions such as Obsessive Compulsive Disorder [10], Postpartum Psychosis [11], and Parkinson’s disease [12], with varying degrees of success
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