Background: There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the COVID-19 pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center.

scientists had isolated a new type of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from these patients. It was hypothesized that the outbreak was associated with a seafood market in Wuhan (1).China promptly adopted public health measures to prevent and control the epidemic, including isolating patients, monitoring their contacts, and developing diagnostic and treatment procedures (2). However, the number of confirmed cases continued to increase, and the disease spread to other countries.The first cases of coronavirus disease (COVID-19) outside China were reported in Thailand, Japan, and Korea. Since then, COVID-19 has spread to American and European territories. By the time the World Health Organization declared a pandemic on March 11, 2020, there were approximately 118,000 cases of COVID-19, with 4,291 deaths in 114 countries (1).In the American continent, the first case was reported in the United States of America on January 21, 2020, followed by Canada, which reported its first case four days later. In South America, the first case was confirmed on February 26, 2020 in the city of São Paulo, Brazil. By May 7, 2020, the country had already 135,106 confirmed cases and 9,146 deaths (3). However, these numbers are likely underreported. In addition to the absence of proper screening mechanisms for asymptomatic patients (4), Brazil's health system suffers from a chronic lack of testing for suspected cases and deaths, as is the case in a number of developing countries.

Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although nonimplantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms Brazilian Psychiatric Association 0 0 0 0 0 0 0 0 -0 0 0 2 -7 3 1 6 -1 1 8 5 associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ''precision-oriented'' practice. DisclosureZ-DD is listed as inventor on patents/patent applications related to brain stimulation technology, assigned to Columbia University and NEVA Electromagnetics, not licensed, and with no remuneration. Although he is an employee of the U.S. government, the views expressed Braz J Psychiatry. 2020;00 (00) Precision NIN for depression

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

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