Table 106Summary of findings on nonpharmacologic treatment of adult treatment-resistant depression (TRD) with strength of evidence for Tier 1 (TRD) for KQ 6. health-related outcomes

ComparisonOutcomeNumber of SubjectsStrength of Evidence*Findings
ECT vs. ECT + rTMSHealth-related outcomes22LowThere were no differences between groups in improvements in daily functioning.
rTMS vs. shamHealth-related outcomes60Low1 fair trail: low rTMS had significantly greater improvement in health status and daily functioning than sham, while this relationship approached statistical significance when comparing high rTMS to sham.
VNS vs. shamHealth-related outcomes214Low1 fair trial: VNS and sham groups did not differ significantly in daily functioning.
CBT/DBT vs. controlHealth-related outcomes0NANo eligible studies identified.

CBT = cognitive behavioral therapy; DBT = dialectical behavioral therapy; NA = not applicable; 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 and/or Tier 3 study addressed this comparison.

From: Discussion

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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