Eight Treatments For TRD: Systematic Review From China

Out on PubMed, from authors in China, is this paper: 

Efficacy and safety of eight enhanced therapies for treatment-resistant depression: A systematic review and network meta-analysis of RCTs.

Guo Q, Guo L, Wang Y, Shang S.Psychiatry Res. 2024 Jun 20;339:116018. doi: 10.1016/j.psychres.2024.116018. Online ahead of print.PMID: 38924903

The abstract is copied below:

Background: Treatment-Resistant Depression (TRD) challenges psychiatric treatment, with existing guidelines covering only a subset of augmentation strategies.

Methods: A network meta-analysis following PRISMA guidelines examined the efficacy and safety of TRD treatments, analyzing 72 randomized controlled trials from eight databases, assessing response and remission rates, tolerability, and safety through the Cochrane Risk of Bias Tool and CINeMA framework.

Findings: Including 12,105 participants, the analysis highlighted ECT, Ketamine, Esketamine, and Psilocybin as superior first-line treatments due to their optimal balance between effectiveness and tolerability. Brexpiprazole and Quetiapine showed no significant efficacy over placebo in response rates, while Esketamine and Psilocybin exhibited lower tolerability.

Interpretation: The results advocate for ECT, Ketamine, Esketamine, and Psilocybin as preferred treatments for TRD, guiding clinical practice with evidence-based recommendations for enhancing treatment outcomes. This study underscores the importance of considering both efficacy and safety in selecting augmentation strategies for TRD.

Keywords: Enhanced Innovative Therapies; Network meta-analysis; Treatment-resistant depression.

The paper is here.

And from the text:

This is a monumental effort from authors with affiliations at a school of nursing in Beijing.

It documents the efficacy and safety of ECT, no surprise, as a reflection of the literature.