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expert reaction to systematic review and network meta-analysis on non-surgical brain stimulation for acute treatment of major depressive episodes

Research published in The BMJ provide evidence for the consideration of brain stimulation techniques as alternatives or supplements for adults with major depressive episodes.

Prof Anthony Cleare, Professor of Affective Disorders, King’s College London, said:

“This study looked at all the clinical trials conducted to date and concludes that several brain stimulation techniques are an effective treatment for depression. Many patients are not helped by, or are unable to tolerate, other forms of treatment such as medication or psychotherapies.  Some patients may also have a personal preference for these forms of treatment. Unfortunately, in most areas of the country, few if any of these types of neurostimulation treatments are available.

“Further work is needed to fine tune some of these treatments, to identify which patients are most likely to respond to which treatments, and to look at longer term outcomes, so clearly more high-quality studies are still needed.  Nevertheless, this study supports the case for brain stimulation treatments to be more widely available as an option for patients and clinicians.”

Dr Derek Tracy, Royal College of Psychiatrists, said:

“The need for new treatments for depression are clear. For now we only have a partial understanding of how these treatments change brain functioning and how it might help treat mental illness. While the study is methodologically robust, it does highlight some key limitations. Notably, many of the reviewed trials are of themselves relatively small and brain stimulation is often given, understandably, to those who have already failed to show improvement to more standard care. Two critical questions emerge that will need tackling: can we determine which specific individuals might benefit most from these treatments, and can we refine the interventions further to maximise any effectiveness.”

‘Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis’ by Julian Mutz et al. was published in The BMJ at 23:30 UK time on Wednesday 27th March.

Declared interests

Prof Anthony Cleare: Prof Cleare has in the last three years received honoraria for speaking from Lundbeck; honoraria for consulting from Livanova, Lundbeck and Janssen; sponsorship for conference attendance from Janssen; and research grant support from the Medical Research Council (UK), Wellcome Trust (UK) and the National Institute for Health Research. (UK). Prof Cleare works in the same Institution as some of the authors of this paper but was not involved in this piece of work.

Dr Derek Tracy: Dr Tracy is a senior lecturer at Kings College but has nothing to do with the study or have any other declarations of interest.

None others received

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