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Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults

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Findings of the Comparative Effectiveness Review: rTMS ± ECT Versus ECT Alone

Evidence of low strength shows that:

  • rTMS does not clearly differ from ECT with respect to depression severity, response rates, and remission rates.
  • ECT and rTMS groups may not differ with respect to withdrawals because of adverse events.
  • Overall withdrawal rates were lower with rTMS than with ECT.
  • Treatment interventions combining ECT with rTMS do not clearly differ from treatment with ECT alone with respect to depression severity, remission rates, improvements to daily functioning, or specific adverse events.

Evidence is insufficient to evaluate ECT versus rTMS with respect to adverse events and effects on cognitive or daily functioning.