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Table ASummary of findings on nonpharmacologic treatment of adult treatment-resistant depression (TRD) with strength of evidence for Tier 1 (TRD) for Key Question 1a, comparative efficacy of nonpharmacologic treatments

ComparisonOutcomeNumber of SubjectsStrength of Evidence*Findings
ECT vs. rTMSChange in depressive severity42Low1 fair trial: both ECT and rTMS improved symptom severity but did not differ significantly.
ECT vs. rTMSResponse rate42Low1 fair trial: ECT and rTMS did not differ significantly.
ECT vs. rTMSRemission rate42Low1 fair trial: ECT and rTMS did not differ significantly.
ECT plus rTMS vs. ECTChange in depressive severity22Low1 fair trial: both ECT and ECT plus rTMS improved symptom severity but did not differ significantly.
ECT plus rTMS vs. ECTResponse rate0NANo eligible studies identified.
ECT plus rTMS vs. ECTRemission rate22Low1 fair trial: ECT and ECT plus rTMS did not differ significantly.
ECT vs. shamChange in depressive severity0NANo eligible studies identified.
ECT vs. shamResponse rate0NANo eligible studies identified.
ECT vs. shamRemission rate0NANo eligible studies identified.
rTMS vs. shamChange in depressive severity497High7 trials (3 good, 4 fair): rTMS had a significantly greater decrease in depressive severity than sham. 4 fair trials: rTMS had nonsignificantly greater decrease in depressive severity than sham.
2 fair trials: rTMS had greater decrease than sham but significance NR.
1 fair trial: rTMS did not significantly differ from sham.
rTMS vs. shamResponse rate471High4 trials (3 good, 1 fair): rTMS had a significantly higher response rate than sham.
1 fair trial: rTMS had a nonsignificantly higher response rate than sham.
6 fair trials: rTMS had a higher response rate than sham, but significance NR.
1 fair trial: rTMS did not clearly differ from sham, but significance NR.
rTMS vs. shamRemission rate223Moderate3 trials (2 good, 1 fair): rTMS had significantly greater remission rate than sham.
1 fair trial: rTMS had a greater remission rate than sham but significance NR.
VNS vs. shamChange in depressive severity235Low1 good trial: VNS and sham did not differ significantly.
VNS vs. shamResponse rate235Low1 good trial: VNS and sham did not differ significantly.
Psychotherapy vs. controlChange in depressive severity0NANo eligible studies identified.
Psychotherapy vs. controlResponse rate0NANo eligible studies identified.
Psychotherapy vs. controlRemission rate0NANo eligible studies identified.

ECT = electroconvulsive therapy; NA = not applicable; NR = not reported; rTMS = repetitive transcranial magnetic stimulation; VNS = vagus nerve stimulation; vs. = versus

*

Strength of evidence is based on guidance provided in the AHRQ Methods Guide for Comparative Effectiveness Reviews; see text.

Good and fair designations relate to quality ratings for each study.

At least one Tier 2 or Tier 3 study addressed this comparison.

Strength of evidence is based on guidance provided in the AHRQ Methods Guide for Comparative Effectiveness Reviews; see text.

Good and fair designations relate to quality ratings for each study.

At least one Tier 2 or Tier 3 study addressed this comparison.

From: Executive Summary

Cover of Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults
Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults [Internet].
Comparative Effectiveness Reviews, No. 33.
Gaynes BN, Lux LJ, Lloyd SW, et al.

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