文献类型：期刊文献

英文题名：Efficacy of non-invasive brain stimulation combined with antidepressant medications for depression: a systematic review and meta-analysis of randomized controlled trials

作者：Tao, Yuan[1];Liang, Qian[1];Zhang, Fenghong[2];Guo, Shaofan[1];Fan, Lingyun[2];Zhao, Fei[3]

第一作者：Tao, Yuan

通信作者：Zhao, F[1]

机构：[1]Gansu Univ Chinese Med, Sch Nursing, Lanzhou 73000, Peoples R China;[2]Second Prov Peoples Hosp Gansu, Lanzhou 73000, Peoples R China;[3]Northwest Minzu Univ, Key Lab Environm Ecol & Populat Hlth Northwest Min, Med Coll, Lanzhou 730030, Peoples R China

第一机构：甘肃中医药大学护理学院

通信机构：[1]corresponding author), Northwest Minzu Univ, Key Lab Environm Ecol & Populat Hlth Northwest Min, Med Coll, Lanzhou 730030, Peoples R China.

年份：2024

卷号：13

期号：1

外文期刊名：SYSTEMATIC REVIEWS

收录：;Scopus(收录号：2-s2.0-85188234960);WOS:【SCI-EXPANDED(收录号:WOS:001190549300001)】；

基金：This work was Supported by Gansu Province Outstanding Graduate Student Innovation Star Fundy2023CXZX-766).

语种：英文

外文关键词：NIBS; Depression; Transcranial magnetic stimulation; Transcranial direct current stimulation

摘要：Background Antidepressants, noninvasive brain stimulation (NIBS), and their combination are commonly used in routine clinical practice. Nevertheless, there is a continuous dispute regarding whether the effectiveness of NIBS in combination with antidepressants exceeds that of antidepressants alone. This meta-analysis aimed to evaluate the existing evidence and draw a definitive conclusion on this issue. Methods We conducted a comprehensive search of five databases: Embase, PubMed, Web of Science, SinoMed, and the Cochrane Database of Randomized Controlled Trials. The search was conducted until October 6, 2023. The primary outcomes were the pre- and post-intervention depression and anxiety scores. Secondary outcomes included dropout rates, response rates, and certain levels of neurotransmitters [ 5-hydroxytryptamine (5-HT), dopamine (DA), and gamma-aminobutyric acid (GABA)] at the end of the intervention. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. The data were analysed using R 4.2.2. Results We included 18 RCTs [1357 participants; 11 studies used repetitive transcranial magnetic stimulation (rTMS) and 7 studies used transcranial direct current stimulation (tDCS)]. The follow-up duration varied from two weeks to three months. Overall, whether in combination with rTMS or tDCS, antidepressants proved more effective in alleviating depressive symptoms compared to when used as monotherapy. However, this advantage was not evident during the follow-up period. (p > 0.05). And the combination's efficacy in improving anxiety was found to be lacking. Post-treatment serum levels of 5-HT, DA, and GABA were higher in the rTMS group were higher than antidepressant medication group (p < 0.05). Furthermore, subgroup analysis results indicated that only the rTMS + antidepressant medication treatment significantly improved remission and remission rates. The meta-regression results showed that the type of antidepressant and the sex of the participants had a significant association with the depression score. Conclusion Combination treatment with NIBS was significantly more effective in improving depression symptoms than medication alone. rTMS combined with antidepressants appears to be more effective in improving response and remission rates. However, efficacy may be influenced by the type of medicine used in combination, and long-term efficacy data is lacking. Systematic review registration PROSPERO CRD42023388259.