title: Comparative efficacy and acceptability of electroconvulsive therapy versus repetitive transcranial magnetic stimulation for major depression: A systematic review and multiple-treatments meta-analysis.
abstract: The effects of electroconvulsive therapy (ECT) and bilateral, left prefrontal, and right prefrontal repetitive transcranial magnetic stimulation (rTMS) on major depressive disorder (MDD) have not been adequately addressed by previous studies. Here, a multiple-treatments meta-analysis, which incorporates evidence from direct and indirect comparisons from a network of trials, was performed to assess the efficacy and acceptability of these four treatment modalities on MDD.
  
  
  
  The literature was searched for randomized controlled trials (RCTs) on ECT, bilateral rTMS, and unilateral rTMS for treating MDD up to May 2016. The main outcome measures were response and drop-out rates.
  
  
  
  Data were obtained from 25 studies consisting of 1288 individuals with MDD. ECT was non-significantly more efficacious than B-rTMS, R-rTMS, and L-rTMS. Left prefrontal rTMS was non -significantly less efficacious than all other treatment modalities. In terms of acceptability, R-rTMS was non-significantly better tolerated than ECT, B-rTMS, and L-rTMS. ECT was the most efficacious treatment with the cumulative probabilities of being the most efficacious treatment being: ECT (65%), B-rTMS (25%), R-rTMS (8%), and L-rTMS (2%). R-rTMS was the best-tolerated treatment with the cumulative probabilities of being the best-tolerated treatment being: R-rTMS (52%), B-rTMS (17%), L-rTMS (16%), and ECT (14%). Coherence analysis detected no statistically significant incoherence in any comparisons of direct with indirect evidence for the response rate and drop-out rate.
  
  
  
  ECT was the most efficacious, but least tolerated, treatment, while R-rTMS was the best tolerated treatment for MDD. B-rTMS appears to have the most favorable balance between efficacy and acceptability.
authors.affiliation: Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Institute of Life Sciences, Chongqing Medical University, China; Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China; Department of Neurology, Yongchuan Hospital of Chongqing Medical University, China.
authors.forename: Li-Bo
authors.initials: LB
authors.lastname: Zhao
authors.affiliation: Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, China.
authors.forename: Yi-Yun
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, China.
authors.forename: Song-Hua
authors.initials: SH
authors.lastname: Fan
authors.affiliation: Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China; Department of Neurology, Yongchuan Hospital of Chongqing Medical University, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, China. Electronic address: xiepeng@cqmu.edu.cn.
authors.forename: Peng
authors.initials: P
authors.lastname: Xie
mesh_terms: D000818:Animals; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy; D006801:Humans; D050781:Transcranial Magnetic Stimulation
keywords: Depression; ECT; Electroconvulsive therapy; MDD; Meta-analysis; TMS; Transcranial magnetic stimulation; rTMS