COMPARATIVE EFFICACY OF ELECTROCONVULSIVE THERAPY, TRANSCRANIAL MAGNETIC STIMULATION AND OTHER NOVEL PHARMACOLOGICAL APPROACHES FOR THE ACUTE TREATMENT OF MAJOR DEPRESSIVE EPISODES IN ADULTS: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract Background Major depressive episodes can severely impair daily functioning and quality of life, making it crucial to identify the most effective treatments. Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and novel pharmacological approaches are increasingly used but have not been comprehensively compared. Objectives The aim of this network meta-analysis is to compare the efficacy of ECT, TMS, and ketamine for the acute treatment of major depressive episodes in adults. Methods A systematic review and network meta-analysis were carried out following the PRISMA guidelines. We systematically searched the PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) published up to September 2023. Our primary outcome of interest was the reduction in depression scale scores. To ensure the quality of the included studies, we exclusively considered RCTs involving adult human participants and published as peer-reviewed articles, with a specific focus on head-to-head comparative studies. Results In our analysis, we included a total of 13 randomized controlled trials (RCTs) involving 599 patients to evaluate the reduction in depression scale scores. Among the specific interventions compared, ECT demonstrated the highest efficacy, with a statistically significant reduction in depression scale scores compared to TMS (Standardized Mean Difference (SMD): 0.07, 95% Confidence Interval (CI): 0.01 to 0.69). However, when compared to ketamine, there was no statistically significant difference observed (SMD: 0.07, 95% CI: 0.00 to 1.19). Notably, ketamine also showed a significant reduction in depression scale scores compared to TMS (SMD: 0.90, 95% CI: 0.02 to 35.96). Among these interventions, ECT had the highest probability of being the most effective treatment, with a surface under the cumulative ranking value of 91.2. Conclusion Our network meta-analysis suggests that ECT is the most effective acute treatment for major depressive episodes in adults, followed by ketamine.