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Adjunctive Nonconvulsive Electrotherapy for Patients with Depression: a Systematic Review

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Abstract

The efficacy and safety of adjunctive nonconvulsive electrotherapy (NET) for patients with depression are undetermined. This systematic review was conducted to examine the efficacy and safety of adjunctive NET for patients with depression. Chinese (WanFang and Chinese Journal Net) and English (PubMed, EMBASE, PsycINFO and the Cochrane Library) databases were systematically searched from their inception until Jan 27, 2021 by three independent investigators. One randomized controlled trial (RCT) with 3 treatment arms (n = 108) and two observational studies (single-group, before-after design, n = 31) were included. In the RCT, the antidepressant efficacy of NET on depression was similar to that of electroconvulsive therapy (ECT) (P > 0.05) but with significantly fewer neurocognitive impairments as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (P < 0.05). In two observational studies, the 17-item Hamilton Depression Rating Scale (HAMD-17) scores decreased significantly from baseline to post-NET (all Ps < 0.05), without adverse neurocognitive effects. In the RCT, adverse drug reactions (ADRs) were not separately reported among the 3 treatment arms but a similar rate of discontinuation was reported. The currently available limited evidence from 3 studies suggests that NET as an adjunctive treatment may be a safe, well-tolerated, effective therapy for depression without serious neurocognitive impairments.

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Abbreviations

ADs:

Antidepressants

ADRs:

Adverse drug reactions

CBF:

Cerebral blood flow

dTMS:

Deep transcranial magnetic stimulation

ECT:

Electroconvulsive therapy

HAMD-17:

17-Item Hamilton Depression Rating Scale

HF-rTMS:

High-frequency repeated transcranial magnetic stimulation

LF-rTMS:

Low-frequency repeated transcranial magnetic stimulation

MCCB:

MATRICS Consensus Cognitive Battery

MMSE:

Mini-Mental State Exam

NET:

Nonconvulsive electrotherapy

RBANS:

Repeatable Battery for the Assessment of Neuropsychological Status

RCT:

Randomized controlled trial

rTMS:

Repeated transcranial magnetic stimulation

TMS:

Transcranial magnetic stimulation

TRD:

Treatment-refractory depression

WCST:

Wisconsin Card Sorting Test

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Acknowledgements

None.

Funding

This study was funded by the Science and Technology Planning Project of Liwan District of Guangzhou (202004034), Guangzhou Health Science and Technology Project (20211A011045), Guangzhou science and Technology Project of traditional Chinese Medicine and integrated traditional Chinese and Western medicine (20211A011045), China International Medical Exchange Foundation (Z-2018–35-2002), Guangzhou Clinical Characteristic Technology Project (2019TS67), and Guangdong Hospital Association (2019ZD06). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Dong-Bin Cai, Hua-Rong Zhou and Wan-Nian Liang contributed equally to this work.

Authors and Affiliations

  1. Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China

    Dong-Bin Cai

  2. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China

    Hua-Rong Zhou, Li-Mei Gu, Xiong Huang & Wei Zheng

  3. Wanke School of Public Health, Tsinghua University, Beijing, China

    Wan-Nian Liang

  4. Nanning Fifth People’s Hospital, Nanning, China

    Mei He

  5. Chongqing Jiangbei Mental Health Center, Chongqing, China

    Zhan-Ming Shi

  6. Yangjiang Public Health Hospital, Yangjiang, China

    Hua-Cheng Hou

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  1. Dong-Bin Cai
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Contributions

Study design: WZ and HCH; Data extraction: DBC, LMG and MH; Data analysis: DBC, LMG and MH; Drafting of the manuscript: DBC, HCH and WZ. Critical revision of the manuscript: XH and ZMS; Approval of the final version for publication: All the author.

Corresponding authors

Correspondence to Hua-Cheng Hou or Wei Zheng.

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Cai, DB., Zhou, HR., Liang, WN. et al. Adjunctive Nonconvulsive Electrotherapy for Patients with Depression: a Systematic Review. Psychiatr Q 92, 1645–1656 (2021). https://doi.org/10.1007/s11126-021-09936-5

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  • DOI: https://doi.org/10.1007/s11126-021-09936-5

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