Thread by @PGCgenetics

(1/9) A brief thread by @julianmutz on brain stimulation treatments for individuals with #depression

Please RT! #Psychiatry #Brainstimulation

Some recent findings summarised below 👇

(2/9) Pharmacological & psychological treatments for depression, while effective in many patients, have limited efficacy in some patients and/or are sometimes not well tolerated.

Brain stimulation could be considered as additional or alternative treatment in these patients.

(3/9) In a 2018 meta-analysis we analysed data from 54 clinical trials that included a total of almost 3000 patients.

doi.org/10.1016/j.neub…

(4/9) The evidence supported efficacy of

☑️HF-L rTMS
☑️LF-R rTMS
☑️bilateral rTMS
☑️deep TMS
☑️intermittent TBS
☑️tDCS

but not

✖️continuous TBS
✖️bilateral TBS
✖️synchronised TMS

There were no differences in all-cause discontinuation rates (used to estimate acceptability).

(5/9) Subsequently we published a network meta-analysis in @bmj_latest doi.org/10.1136/bmj.l1…

This is the most comprehensive NMA of brain stimulation to date and included 18 active treatment protocols 👇 & sham, with a total of up to 6750 patients.

@KingsIoPPN @kclcfad

(6/9) We found that most treatment protocols were more efficacious than sham (see data for response rates below) & were not associated with higher all-cause discontinuation rates.

Previous thread:

https://twitter.com/julianmutz/status/1111214359685025793?s=20

(7/9) In this network meta-analysis we did not examine potential cognitive effects of brain stimulation.

However, work in collaboration with @kiebs @HurlemannRene is ongoing, see our protocol in @BMJ_Open

bmjopen.bmj.com/content/9/2/e0… #openaccess #brainstimulation

(8/9) While most brain stimulation studies included patients with treatment resistant depression, more data are needed in medication-naive and first onset depression, as we have argued in a 2019 editorial in @TheBJPsych

doi.org/10.1192/bjp.20…

@kiebs @HurlemannRene

(9/9) In a recent review in @IntRevPsych we also discussed the possibility of using transcranial direct current stimulation #tDCS as a first-line treatment in some patients, especially because of tDCS could be used in the home environment.

doi.org/10.1080/095402… @RaeResearch