Brain stimulation and other biological non-pharmacological interventions in mental disorders: an umbrella review


Author: Stella Rosson1, Renato de Filippis2, Giovanni Croatto3, Enrico Collantoni3, Simone Pallottino4, Daniel Guinart5, Andre R Brunoni6, Bernardo Dell'Osso7, Giorgio Pigato3, Joshua Hyde8, Valerie Brandt8, Samuele Cortesem9, Jess G Fiedorowicz10, Georgios Petrides11, Christoph U Correll12, Marco Solmi13

Affiliation: <sup>1</sup> Department of Mental Health, AULSS 3 Serenissima, Venice, Italy; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Neurosciences, University of Padua, Padua, Italy.

<sup>2</sup> Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

<sup>3</sup> Department of Neurosciences, University of Padua, Padua, Italy.

<sup>4</sup> Department of Mental Health and Addiction, ASL Roma5, Rome, Italy.

<sup>5</sup> Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain.

<sup>6</sup> Departamentos de Clínica Médica e Psiquiatria, Faculdade de Medicina da USP; Service of Interdisciplinary Neuromodulation (SIN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP.

<sup>7</sup> Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, California, USA; Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy.

<sup>8</sup> Centre for Innovation in Mental Health, School of Psychology, University of Southampton Southampton, UK.

<sup>9</sup> Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA.

<sup>10</sup> Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada.

<sup>11</sup> Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Division of ECT, Zucker Hillside Hospital, Northwell Health, Hempstead, USA.

<sup>12</sup> Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Germany.

<sup>13</sup> Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario; Centre for Innovation in Mental Health, School of Psychology, University of Southampton Southampton, UK. Electronic address: msolmi@toh.ca.
Conference/Journal: Neurosci Biobehav Rev
Date published: 2022 Jun 14
Other:
  Special Notes: doi: 10.1016/j.neubiorev.2022.104743.   ,  Word Count: 261  
    Background:

The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear.



Methods:

We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE.



Results:

We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low.



Discussion:

Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines.



Funding:

None.



Keywords: DBS; ECT; TMS; VNS; biological non-pharmacological treatments; deep brain stimulation; electro-convulsive therapy; light therapy; mental health; meta-analysis; tDCS; transcranial direct current stimulation; transcranial magnetic stimulation; umbrella review; vagus nerve stimulation.



PMID: 35714757 DOI: 10.1016/j.neubiorev.2022.104743