Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis
Rada Pineda, Alvaro Javier
Abstract Introduction One possible treatment option for the management of major depressive disorder (MDD) is transcranial magnetic stimulation (TMS) which has shown antidepressant properties superior to placebo with a good safety profile. The aim of this study is to determine the reduction in the severity of MDD and proportion of adverse events (AEs) in patients with refractory and non-refractory MDD, following the use of TMS administered as monotherapy or adjunctive therapy compared to pharmacological therapy. Methodology A systematic search of a PICOT question was performed in the Medline, EMBASE and Cochrane database. Two investigators independently selected citations, assessed of quality using Cochrane Collaboration tool and collected the data. Efficacy data were extracted such as response rate, remission rate, quality of life, symptoms decrease of major depressive disorder in the Hamilton scale and functional capacity. Similarly, proportion of patients with AEs. A meta-analysis of these variables was performed taking into account the heterogeneity. Results This systematic review included 26 randomized trials with low methodological quality showing that TMS had superior efficacy when was used as an adjunct to therapies that were being treated patients with refractory MDD and non-refractory in the outcomes of response rate and percentage of remission. In the case of specific pharmacological interventions, TMS has similarly effective in both monotherapy and adjunctive therapy compared to pharmacological interventions. Regarding to safety, the TMS had a good safety profile because in all scenarios studied the AE were not serious and low frequency Conclusions The available evidence suggests that TMS show to be effective and safe for the management of refractory and non-refractory MDD. However, the evidence is weak therefore major clinical research is necessary in order to support its use.