This paper describes a very interesting systematic review and network meta-analysis exploring interventions for treatment resistant depression including TMS, ECT and various pharmacological interventions. The authors reviewed a total of 31 randomised controlled trials across all three intervention types. Perhaps not surprisingly given that the authors were predominantly from the pharmaceutical industry, the benefits of several antipsychotic drugs were highlighted in the abstract. However, this really misrepresents the findings within the paper which are far more in favour of non-pharmacological treatments.
In particular, when looking at remission and response rates, especially those at four and six weeks (compared to at two weeks), TMS came out looking far and away the most effective treatment intervention. For response rates at four weeks, aripiprazole, ECT and TMS were seen to be effective but the response rates were greatest with TMS. At six week assessment, only TMS demonstrated response rates that were statistically significantly greater than placebo stimulation.
The data describing remission rates at four and six weeks also was quite favourable to TMS: TMS was one of three interventions (including aripiprazole and ECT) that were effective at four weeks and at six weeks it was again the intervention with the highest remission rates and the only intervention where effects were statistically significant (Fig. 4).
This data provides extremely strong support for the relative efficacy of TMS compared to other interventions in patients with treatment resistant depression. It clearly indicates that TMS treatment is as good as, and most likely superior, to most other interventions that are provided to patients who meet criteria for treatment resistance.
Professor Paul B. Fitzgerald