Umbrella Review of Non-Pharmacological Interventions in Psychiatric Illness: ECT Looking Strong

 Out on PubMed,from researchers in North America and Europe, is this review:

Brain stimulation and other biological non-pharmacological interventions in mental disorders: an umbrella review.

Rosson S, de Filippis R, Croatto G, Collantoni E, Pallottino S, Guinart D, Brunoni AR, Dell'Osso B, Pigato G, Hyde J, Brandt V, Cortesem S, Fiedorowicz JG, Petrides G, Correll CU, Solmi M.Neurosci Biobehav Rev. 2022 Jun 14:104743. doi: 10.1016/j.neubiorev.2022.104743. Online ahead of print.PMID: 35714757 Review.

The abstract is copied below:

Background: The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear.

Methods: We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE.

Results: We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low.

Discussion: Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines.

Funding: None.

Keywords: DBS; ECT; TMS; VNS; biological non-pharmacological treatments; deep brain stimulation; electro-convulsive therapy; light therapy; mental health; meta-analysis; tDCS; transcranial direct current stimulation; transcranial magnetic stimulation; umbrella review; vagus nerve stimulation.

The article is here.

And from the text:

This umbrella review includes 20 meta-analyses of ECT. The overall efficacy data for ECT are overwhelming and compelling. This should come as no surprise. The data on ECT's efficacy for the treatment of schizophrenia are noteworthy.

This is a dense paper with lots of subcategories of data to ponder, for those with an interest, an ~ 45-minute read.

Kudos to these authors for showcasing the evidence base for the efficacy of ECT in the literature.