Relative Effectiveness of Antidepressant Treatments in Treatment-resistant Depression: a Systematic Review and Network Meta-analysis of Tandomized Controlled Trials.
Out on PubMed, from authors in Austria and the USA, is this paper:
Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials.
The abstract is copied below:
This systematic review and network meta-analysis (NMA) sought to compare different antidepressant treatments for treatment-resistant depression (TRD) in order to facilitate evidence-based choices. A literature search of PubMed, Cochrane Library, and Embase from inception until April 13th, 2023 identified randomized, controlled trials (RCTs) of adults with depression who had not responded to at least two antidepressant trials; all RCTs had ≥10 participants per study arm, and participants with bipolar or psychotic depression were excluded. The Cochrane Risk of Bias Tool-2 was used to assess study quality. Response rate was the primary outcome measure. Odds ratios (ORs) using a random effects NMA are reported. From 8234 records, 69 RCTs were included in this analysis, encompassing 10,285 participants (5662 F/4623 M) and 25 separate treatments. Six of the 25 treatments demonstrated a higher response rate versus placebo or sham treatment: electroconvulsive therapy (ECT), minocycline, theta-burst stimulation (TBS), repetitive transcranial magnetic stimulation (rTMS), ketamine, and aripiprazole. ORs ranged from 1.9 (95%CI = [1.25; 2.91]) for aripiprazole to 12.86 (95%CI = [4.07; 40.63]) for ECT. Moderate heterogeneity of the model was observed (I2 = 47.3% (95%CI [26.8-62%]). Of the included studies, 12.5% were rated as having high risk of bias, 28.13% as having low risk, and 59.38% as showing some concerns. Several effective treatments for TRD showed robust treatment effects across outcomes (ECT, TBS, rTMS, and ketamine), and others showed promising results for some, but not all, outcomes (minocycline, aripiprazole). These findings may help guide evidence-based treatment choices for TRD. Study Registration: PROSPERO (#CRD42023420584).
The paper is here.
And from the text:
This paper reads like an advertisement for ketamine, although the superiority of the odds ratios for ECT are hard to overlook. Imagine if bipolar and psychotically depressed patients were included!
These authors also bring up the old canard of there having been no sham ECT trials since 1985. Well, parachutes and ECT work; as McDonald's said, millions and millions served!
I think it is quite disingenuous to say, "Another potential treatment for TRD is neuromodulatory procedures..." as if ECT had not already proven itself over many decades.
Unfortunately, these authors espouse an all-too-common opinion, that ECT is an outlier and not part of modern mainstream psychiatry. Well, they are partly correct, as these data show: it is an outlier because it is so far superior to any other treatment for severe depression to date.
Comments
Post a Comment