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Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials

Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials
Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials
Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS), is a potentially effective treatment strategy for a number of mental conditions. However, no quantitative evidence synthesis of randomized controlled trials (RCTs) of TMS or tDCS using the same criteria including several mental conditions is available. Based on 208 RCTs identified in a systematic review, we conducted a series of random effects meta-analyses to assess the efficacy of NIBS, compared to sham, for core symptoms and cognitive functioning within a broad range of mental conditions. Outcomes included changes in core symptom severity and cognitive functioning from pre- to post-treatment. We found significant positive effects for several outcomes without significant heterogeneity including TMS for symptoms of generalized anxiety disorder (SMD = −1.8 (95% CI: −2.6 to −1), and tDCS for symptoms of substance use disorder (−0.73, −1.00 to −0.46). There was also significant effects for TMS in obsessive-compulsive disorder (−0.66, −0.91 to −0.41) and unipolar depression symptoms (−0.60, −0.78 to −0.42) but with significant heterogeneity. However, subgroup analyses based on stimulation site and number of treatment sessions revealed evidence of positive effects, without significant heterogeneity, for specific TMS stimulation protocols. For neurocognitive outcomes, there was only significant evidence, without significant heterogeneity, for tDCS for improving attention (−0.3, −0.55 to −0.05) and working memory (−0.38, −0.74 to −0.03) in individuals with schizophrenia. We concluded that TMS and tDCS can benefit individuals with a variety of mental conditions, significantly improving clinical dimensions, including cognitive deficits in schizophrenia which are poorly responsive to pharmacotherapy.
1359-4184
2709–2719
Hyde, Joshua
93129af5-842a-4601-95d1-e0018098416f
Carr, Hannah Rae
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Kelley, Nicholas
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Seneviratne, Rose
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Reed, Claire Louise
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Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Garner, Matthew
3221c5b3-b951-4fec-b456-ec449e4ce072
Solmi, Marco
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Rosson, Stella
d3ebbd58-a47c-4175-9df9-ebdb229c5ce5
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Brandt, Valerie
e41f5832-70e4-407d-8a15-85b861761656
Hyde, Joshua
93129af5-842a-4601-95d1-e0018098416f
Carr, Hannah Rae
9a1d703f-7057-49d9-af3d-a809fd319a2d
Kelley, Nicholas
445e767b-ad9f-44f2-b2c6-d981482bb90b
Seneviratne, Rose
f58e13c5-c00c-4d78-87a9-6fb91860e2ad
Reed, Claire Louise
465b9fe5-083a-41a3-81e4-c6b1f2efce7b
Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Garner, Matthew
3221c5b3-b951-4fec-b456-ec449e4ce072
Solmi, Marco
8dc5ef1e-4b0d-4047-a55b-6c4c7a93cf00
Rosson, Stella
d3ebbd58-a47c-4175-9df9-ebdb229c5ce5
Cortese, Samuele
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Brandt, Valerie
e41f5832-70e4-407d-8a15-85b861761656

Hyde, Joshua, Carr, Hannah Rae, Kelley, Nicholas, Seneviratne, Rose, Reed, Claire Louise, Parlatini, Valeria, Garner, Matthew, Solmi, Marco, Rosson, Stella, Cortese, Samuele and Brandt, Valerie (2022) Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials. Molecular Psychiatry, 27, 2709–2719. (doi:10.1038/s41380-022-01524-8).

Record type: Article

Abstract

Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS), is a potentially effective treatment strategy for a number of mental conditions. However, no quantitative evidence synthesis of randomized controlled trials (RCTs) of TMS or tDCS using the same criteria including several mental conditions is available. Based on 208 RCTs identified in a systematic review, we conducted a series of random effects meta-analyses to assess the efficacy of NIBS, compared to sham, for core symptoms and cognitive functioning within a broad range of mental conditions. Outcomes included changes in core symptom severity and cognitive functioning from pre- to post-treatment. We found significant positive effects for several outcomes without significant heterogeneity including TMS for symptoms of generalized anxiety disorder (SMD = −1.8 (95% CI: −2.6 to −1), and tDCS for symptoms of substance use disorder (−0.73, −1.00 to −0.46). There was also significant effects for TMS in obsessive-compulsive disorder (−0.66, −0.91 to −0.41) and unipolar depression symptoms (−0.60, −0.78 to −0.42) but with significant heterogeneity. However, subgroup analyses based on stimulation site and number of treatment sessions revealed evidence of positive effects, without significant heterogeneity, for specific TMS stimulation protocols. For neurocognitive outcomes, there was only significant evidence, without significant heterogeneity, for tDCS for improving attention (−0.3, −0.55 to −0.05) and working memory (−0.38, −0.74 to −0.03) in individuals with schizophrenia. We concluded that TMS and tDCS can benefit individuals with a variety of mental conditions, significantly improving clinical dimensions, including cognitive deficits in schizophrenia which are poorly responsive to pharmacotherapy.

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More information

Accepted/In Press date: 10 March 2022
e-pub ahead of print date: 1 April 2022

Identifiers

Local EPrints ID: 456165
URI: http://eprints.soton.ac.uk/id/eprint/456165
ISSN: 1359-4184
PURE UUID: 6799808a-e8a0-4da5-911e-953ec5c3a314
ORCID for Hannah Rae Carr: ORCID iD orcid.org/0000-0001-8348-7325
ORCID for Nicholas Kelley: ORCID iD orcid.org/0000-0003-2256-0597
ORCID for Rose Seneviratne: ORCID iD orcid.org/0000-0002-5593-9483
ORCID for Claire Louise Reed: ORCID iD orcid.org/0000-0003-1385-4729
ORCID for Matthew Garner: ORCID iD orcid.org/0000-0001-9481-2226
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

Catalogue record

Date deposited: 26 Apr 2022 15:12
Last modified: 16 Apr 2024 02:01

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Contributors

Author: Joshua Hyde
Author: Hannah Rae Carr ORCID iD
Author: Nicholas Kelley ORCID iD
Author: Rose Seneviratne ORCID iD
Author: Claire Louise Reed ORCID iD
Author: Valeria Parlatini
Author: Matthew Garner ORCID iD
Author: Marco Solmi
Author: Stella Rosson
Author: Samuele Cortese ORCID iD
Author: Valerie Brandt

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