To the Editor We applaud the attempt by Brunoni et al1 to shed light on the comparative efficacy and safety of various repetitive transcranial magnetic stimulation (rTMS) strategies for treating depressive disorders by performing a network meta-analysis (NMA) on the extant published literature. The unique ability of NMA to leverage indirect evidence for a treatment’s efficacy from a network of clinical trials is a potential advantage; however, as pointed out by Mills et al,2 it can also produce distorted results when the analysis is applied incautiously to treatments (nodes) that are not well connected in the network, ie, those only studied against 1 or 2 comparators.
David Feifel. Network Meta-analysis in Mental Health Research. JAMA Psychiatry. 2017;74(8):850–851. doi:10.1001/jamapsychiatry.2017.1164