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Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review

Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review
Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review
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/GRADE=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/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant 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.
Biological non-pharmacological treatments, DBS, Deep brain stimulation, ECT, Electro-convulsive therapy, Light therapy, Mental health, Meta-analysis, TDCS, TMS, Transcranial direct current stimulation, Transcranial magnetic stimulation, Umbrella review, VNS, Vagus nerve stimulation
0149-7634
Rosson, Stella
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De Filippis, Renato
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Croatto, Giovanni
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Collantoni, Enrico
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Pallottino, Simone
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Guinart, Daniel
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Brunoni, Andre R.
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Dell’osso, Bernardo
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Pigato, Giorgio
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Hyde, Joshua
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Brandt, Valerie
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Cortese, Samuele
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Fiedorowicz, Jess G.
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Petrides, Georgios
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Correll, Christoph U.
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Solmi, Marco
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Rosson, Stella
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De Filippis, Renato
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Croatto, Giovanni
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Collantoni, Enrico
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Pallottino, Simone
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Guinart, Daniel
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Brunoni, Andre R.
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Dell’osso, Bernardo
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Pigato, Giorgio
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Hyde, Joshua
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Brandt, Valerie
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Cortese, Samuele
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Fiedorowicz, Jess G.
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Petrides, Georgios
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Correll, Christoph U.
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Solmi, Marco
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Rosson, Stella, De Filippis, Renato, Croatto, Giovanni, Collantoni, Enrico, Pallottino, Simone, Guinart, Daniel, Brunoni, Andre R., Dell’osso, Bernardo, Pigato, Giorgio, Hyde, Joshua, Brandt, Valerie, Cortese, Samuele, Fiedorowicz, Jess G., Petrides, Georgios, Correll, Christoph U. and Solmi, Marco (2022) Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review. Neuroscience & Biobehavioral Reviews, 139, [104743]. (doi:10.1016/j.neubiorev.2022.104743).

Record type: Review

Abstract

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/GRADE=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/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant 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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Accepted/In Press date: 10 June 2022
e-pub ahead of print date: 14 June 2022
Published date: 1 August 2022
Additional Information: Funding Information: Valerie Brandt receives funding from the Academy of Medical Sciences (AMS). Andre R. Brunoni receives grants from the National Council for Scientific and Technological Development (CNPQ, PQ-1B), the Program of Academic Productivity (PIPA) of the University of São Paulo Medical School, and the São Paulo Research Foundation (Grant Number: 2018/10861–7, 2019/06009–6). Prof. Dell’Osso received speaker honoraria and consultation fees from Janssen, Lundbeck, Otzuka, Angelini, Pfizer, Neuraxpharma and Livanova. Simone Pallottino received honoraria and consultation fees from Janssen. Georgios Petrides received research grant support from the National Institute of Aging (NIA) and National Institute of Mental Health (NIMH). Giorgio Pigato received speaker honoraria or consultation feed from Angelini, AstraZeneca, Chiesi, Eisai, Eli Lilly, Lundbeck, Otsuka, Pfitzer, Recordati. Daniel Guinart has been a consultant and/or has received speaker honoraria from Otsuka America Pharmaceuticals and Janssen Pharmaceuticals. He also has received funding from the Instituto de Salud Carlos III (CM21/00033). Christoph U Correll has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Cardio Diagnostics, Compass, Damitsa, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Relmada, Reviva, Rovi, Seqirus, Servier, SK Life Science, Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Relmada, Reviva, Rovi, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Mindpax, and LB Pharma. Marco Solmi received honoraria/has been consultant for Angelini, Lundbeck. Publisher Copyright: © 2022 Elsevier Ltd
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Keywords: Biological non-pharmacological treatments, DBS, Deep brain stimulation, ECT, Electro-convulsive therapy, Light therapy, Mental health, Meta-analysis, TDCS, TMS, Transcranial direct current stimulation, Transcranial magnetic stimulation, Umbrella review, VNS, Vagus nerve stimulation
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Identifiers

Local EPrints ID: 469050
URI: http://eprints.soton.ac.uk/id/eprint/469050
DOI: doi:10.1016/j.neubiorev.2022.104743
ISSN: 0149-7634
PURE UUID: 8168da3e-9756-4bd9-b0e7-8164446cc1a4
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 05 Sep 2022 17:02
Last modified: 17 Mar 2024 07:25

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Contributors

Author: Stella Rosson
Author: Renato De Filippis
Author: Giovanni Croatto
Author: Enrico Collantoni
Author: Simone Pallottino
Author: Daniel Guinart
Author: Andre R. Brunoni
Author: Bernardo Dell’osso
Author: Giorgio Pigato
Author: Joshua Hyde
Author: Valerie Brandt
Author: Samuele Cortese ORCID iD
Author: Jess G. Fiedorowicz
Author: Georgios Petrides
Author: Christoph U. Correll
Author: Marco Solmi

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