期刊
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS
卷 139, 期 -, 页码 -出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.neubiorev.2022.104743
关键词
Biological non-pharmacological treatments; Deep brain stimulation; DBS; Electro-convulsive therapy; ECT; Light therapy; Mental health; Meta-analysis; Transcranial direct current stimulation; TDCS; Umbrella review; Transcranial magnetic stimulation; TMS; Vagus nerve stimulation; VNS
资金
- Academy of Medical Sciences (AMS)
- National Council for Scientific and Technological Development (CNPQ)
- Program of Academic Productivity (PIPA) of the University of Sao Paulo Medical School
- Sao Paulo Research Foundation
- Janssen
- Lundbeck
- Otzuka
- Angelini
- Pfizer
- National Institute of Aging (NIA)
- National Institute of Mental Health (NIMH)
- Instituto de Salud Carlos III
- Takeda
- [PQ -1B]
- [2018/10861-7]
- [2019/06009-6]
- [CM21/00033]
Biological non-pharmacological treatments are effective and safe for various mental disorders, although the certainty is limited. The results provide guidance for future research and guidelines.
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/GRA-DE=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/GRA-DE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No sig-nificant 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.
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