title: Treatment of Adults With Treatment-Resistant Depression: Electroconvulsive Therapy Plus Antidepressant or Electroconvulsive Therapy Alone? Evidence From an Indirect Comparison Meta-Analysis.
abstract: Electroconvulsive therapy (ECT) and antidepressant are the effective treatment alternatives for patients with treatment-resistant depression (TRD); however, the effects and safety of the ECT plus antidepressant relative to ECT alone remain controversial. We decide to assess the potential of ECT plus antidepressant compared with ECT alone by undertaking an indirect comparison meta-analysis.Databases from PubMed, ISI Web of Science, CENTRAL, Clinicaltrials.gov, EMBASE, CBM (China Biomediccal Literatures Database), and CNKI (China National Knowledge Infrastructure) were searched for relevant studies through November 21, 2014. Literature was screened, data were extracted and methodological quality of the eligible trial was assessed by 2 independent reviewers accordingly. Then, head-to-head and indirect comparison meta-analyses were carried out.A total of 17 studies which including 13 studies regarding ECT plus antidepressant versus antidepressant alone and 4 studies concerning ECT versus antidepressant alone containing a total of 1098 patients were incorporated into this meta-analysis. The head-to-head comparison suggested that response rate can be improved in the ECT plus antidepressant (RR, 1.82; 95% CI, 1.55-2.14) and ECT alone group (RR, 2.24, 95% CI, 1.51-3.33) compared with antidepressant alone, respectively; adverse complications including memory deterioration and somatization were not significantly increased except incidence of memory deterioration in ECT plus antidepressant in the 4th weeks after treatment (RR, 0.09, 95% CI, 0.02-0.49). Indirect comparison meta-analysis showed that no significant differences were detected in response rate and memory deterioration between ECT plus antidepressant and ECT alone. However, ECT plus antidepressant increased the incidence of memory deterioration relative to ECT alone.With present evidence, the regime of ECT plus antidepressant should not be preferentially recommended to treat the patients with TRD relative to ECT alone.
authors.affiliation: From Department of Nursing, Tianjin Hospital, Tianjin, Peoples' Republic of China (G-MS); Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ); School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, Peoples' Republic of China (XT, TS, L-JY, ZZ, YW); School of Nursing, Peking Union Medical College, Beijing, Peoples' Republic of China (SL); and Department of Oncology, Affiliated Hospital of Zunyi Medical College, Zunyi, Peoples' Republic of China (J-GP).
authors.forename: Guo-Min
authors.initials: GM
authors.lastname: Song
authors.forename: Xu
authors.initials: X
authors.lastname: Tian
authors.forename: Ting
authors.initials: T
authors.lastname: Shuai
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Yi
authors.forename: Zi
authors.initials: Z
authors.lastname: Zeng
authors.forename: Shuang
authors.initials: S
authors.lastname: Liu
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhou
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D006801:Humans; D008569:Memory Disorders / Q000209:etiology; D013001:Somatoform Disorders / Q000209:etiology
chemical_list: D000928:Antidepressive Agents