Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

Abstract

The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). Method: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. results: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. Discussion: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches. Key words: comprehensive review, major depressive disorder, ECT, TMS, clinical guidelines.Estratégias de neuromodulação para o tratamento da depressão maior: desafios e recomendações de uma força-tarefa rEsuMo O uso de técnicas de neuromodulação para o tratamento do transtorno depressivo maior (TDM) tem despertado um renovado interesse nos últimos anos com o desenvolvimento de outras intervenções não-farmacólogicas além da eletroconvulsoterapia (ECT), como a estimulação magnética transcraniana (EMT), a estimulação transcraniana por corrente continua (ETCC), a estimulação cerebral profunda (DBS) e a estimulação de nervo vago (VNS). Método: Nós organizamos um grupo de trabalho com vários pesquisadores para discutir os avanços recentes e os principais desafios para o uso da neuromodulação no tratamento os principais desafios da pesquisa na neuromodulação e alternativas para superá-los. Discussão: ECT é o tratamento de primeira linha para depressão grave. EMT e ETCC são estratégias com um perfil benigno de efeitos adversos; contudo, enquanto os efeitos da EMT são comparáveis ao das drogas antidepressivas para o tratamento da TDM, a eficácia da ETCC ainda precisa ser estabelecida por mais pesquisas clínicas. DBS e VNS são intervenções invasivas com um papel possível para a depressão refratária. Em resumo, TDM é uma condição crônica, incapacitante e de alta prevalência; portanto na prática clínica todas as opções de tratamento possíveis, incluindo as farmacológicas e não-farmacológicas, devem ser consideradas. Palavras-chave: artigo de revisão, tra...

Therapeutic interventions for vascular depression: a systematic review

“…In addition, all studies except one had blinding issues, as two of them 23,24,32 compared active vs. sham transcranial magnetic stimulation (TMS), a non-pharmacological intervention particularly vulnerable to blind breaking; 33 while the others used nimodipine; 21,22 which is an anti-hypertensive drug that must be up-titrated accordingly to tolerability, thus harming study blinding. This suggests performance bias.…”

Mood disorders in children and adolescents: update for pediatricians

“…Evidências científicas também demonstraram que o eletrochoque pode ser efetivo no tratamento de alguns pacientes adultos com TD refratário aos medicamentos atualmente disponíveis, porém essa modalidade de tratamento ainda não foi validada para crianças e adolescentes 77 . Experimentos utilizando modelos animais mostraram que ratos submetidos a eletrochoque apresentaram na região do hipocampo aumento da acetilação da proteína histona H3 no promotor-gene 3 e fator cerebral de crescimento -brain derived nerve growth factor (BDNF).…”

The Use of ECT and MST in treating depression

“…The risks associated with general anaesthesia and its poor public image explain why ECT is not generally a fi rst line treatment for depression; however, it has been recommended for fi rst-line treatment of depression where there is rapidly deteriorating physical status, repeated medication intolerance and acute suicidal ideation (Brunoni et al, 2010;Kennedy et al, 2009). It is effective for treatment of depression across all ages , but may be particularly useful for elderly patients with psychotic depression (Moksnes & Ilner, 2010).…”

“…Major depression is a leading cause of morbidity and mortality, with a lifetime prevalence of 6 -12% (Brunoni et al, 2010). Psychological and pharmacological treatments are effective for some, but not all patients, and there is also the issue that delay in response to treatment can leave patients at serious risk of suicide or self-neglect, such as dehydration and starvation.…”