A narrative review on invasive brain stimulation for treatment-resistant depression

• Autor(a) principal: Dandekar,Manoj P.
• Data de Publicação: 2022
• Outros Autores: Diaz,Alexandre P., Rahman,Ziaur, Silva,Ritele H., Nahas,Ziad, Aaronson,Scott, Selvaraj,Sudhakar, Fenoy,Albert J., Sanches,Marsal, Soares,Jair C., Riva-Posse,Patricio, Quevedo,Joao
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Brazilian Journal of Psychiatry (São Paulo. 1999. Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462022000300317
• topic: Treatment-resistant depression; deep brain stimulation; vagus nerve stimulation; epidural cortical stimulation subcallosal cingulate gyrus; medial forebrain bundle

While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.