Doctors should consider brain stimulation as an alternative treatment for people living with severe depression, finds a new review.
Some of these people have treatment-resistant depression, which means common prescription drugs do not alleviate the symptoms.
Recent studies have pointed to alternative treatment methods for major depression, such as non-invasive brain stimulation techniques.
For instance, a study that appeared at the end of last year showed that using small electric currents to stimulate a brain area called the orbitofrontal cortex significantly improves the mood of people who did not benefit from conventional antidepressants.
An even more recent trial of a form of brain stimulation called "transcranial alternating current stimulation" (tACS) found that the technique halved depression symptoms in almost 80 percent of the study participants.
Despite such promising results, doctors do not use these techniques widely, as there is not enough data available on their efficacy.
So, a team of researchers led by Julian Mutz at the Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom, set out to review some clinical trials that have examined the benefits of non-invasive brain stimulation techniques for people living with depression.
Brain stimulation as additional treatment
Specifically, Mutz and team examined the results of 113 clinical trials. Overall, these trials included 6,750 participants who were 48 years old, on average, and were living with major depressive disorder or bipolar depression.
The original clinical trials involved randomly assigning these participants to 18 treatment interventions or "sham" therapies. The reviewers focussed on the response, or "efficacy" of the treatment, as well as the "discontinuation of treatment for any reason" — or "acceptability" of the therapies. Mutz and colleagues also rated the trials' risk of bias.
The therapies included in the review were "electroconvulsive therapy (ECT), transcranial magnetic stimulation (repetitive (rTMS), accelerated, priming, deep, and synchronized), theta burst stimulation, magnetic seizure therapy, transcranial direct current stimulation (tDCS), or sham therapy."
Of these, the treatments that the researchers in the original trial examined most often were high frequency left rTMS and tDCS, which they tested against sham therapy. On the other hand, not many trials covered more recent forms of brain stimulation, such as magnetic seizure therapy and bilateral theta burst stimulation, the review found.
Kutz and his team deemed 34 percent of the trials they reviewed as having a low risk of bias. They considered half of the trials to have an "unclear" risk of bias, and finally, 17 percent to have a high risk of bias. The newer the treatments, the higher was the uncertainty of the trials' results.
The review found that bitemporal ECT, high dose right unilateral ECT, high frequency left rTMS and tDCS were all significantly more effective than sham therapy both in terms of efficacy and acceptability.
When considering "discontinuation of treatment for any reason," the researchers found that the participants were not any likelier to discontinue brain stimulation treatments than they were sham therapy. Mutz and colleagues conclude:
"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 randomized controlled trials comparing novel treatments, and sham-controlled trials investigating magnetic seizure therapy," the authors add.
Finally, the researchers also note that their results have clinical implications, "in that they will inform clinicians, patients, and healthcare providers on the relative merits of multiple non-surgical brain stimulation techniques."