Precision non-implantable neuromodulation therapies: a perspective for the depressed brain
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/105843 https://doi.org/10.1590/1516-4446-2019-0741 |
Resumo: | 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 non-implantable 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 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. |
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Precision non-implantable neuromodulation therapies: a perspective for the depressed brainMajor depressive disordertranscranial magnetic stimulationtranscranial direct current stimulationelectroconvulsive therapyprecision medicineBrainDeep Brain StimulationDepressionDepressive Disorder, MajorHumansTranscranial Magnetic StimulationTreatment OutcomeElectroconvulsive TherapyTranscranial Direct Current StimulationCurrent 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 non-implantable 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 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.AGA is supported by Fundac¸a˜o para a Cieˆncia e Tecnologia and Programa COMPETE, Portugal (grant PTDC/ MHC-PAP/5618/2014 [POCI-01-0145-FEDER-016836]; http://www.poci-compete2020.pt/). Z-DD is supported by the National Institute of Mental Health Intramural Research Program (grant ZIAMH002955) and by a Young Investigator Award from the Brain & Behavior Research Foundation (grant 26161). SMM receives research support from the National Institutes of Health (NIH) and is a consultant to Pearson Assessment. JO’S is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (grant 215451/Z/19/Z). ICP is supported by funding from Secretaria Nacional de Polı´ticas sobre Drogas (SENAD) and Conselho Nacional de Desenvolvimento Cientı´fico e Tecnolo´gico (CNPq). LBR is supported by Fundac¸a˜o de Amparo a` Pesquisa do Estado de Sa˜o Paulo (FAPESP; grant 2019/07256-7). ARB is supported by productivity grants from CNPq-1B and the Programa de Incentivo a` Produtividade Acadeˆmica (PIPA), Faculdade de Medicina, Universidade de Sa˜o Paulo (USP).Associacao Brasileira de Psiquiatria2020-08info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/105843http://hdl.handle.net/10316/105843https://doi.org/10.1590/1516-4446-2019-0741eng1809-452X1516-4446Borrione, LucasBellini, HelenaRazza, Lais BoralliÁvila, Ana G.Baeken, ChrisBrem, Anna-KatharineBusatto, GeraldoCarvalho, Andre F.Chekroud, AdamDaskalakis, Zafiris J.Deng, Zhi-DeDownar, JonathanGattaz, WagnerLoo, ColleenLotufo, Paulo AMartin, Maria da Graça M.McClintock, Shawn M.O'Shea, JacintaPadberg, FrankPassos, Ives C.Salum, Giovanni A.Vanderhasselt, Marie-AnneFraguas, RenerioBenseñor, IsabelaValiengo, LeandroBrunoni, Andre R.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-21T16:35:02Zoai:estudogeral.uc.pt:10316/105843Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:22:20.541533Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
title |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
spellingShingle |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain Borrione, Lucas Major depressive disorder transcranial magnetic stimulation transcranial direct current stimulation electroconvulsive therapy precision medicine Brain Deep Brain Stimulation Depression Depressive Disorder, Major Humans Transcranial Magnetic Stimulation Treatment Outcome Electroconvulsive Therapy Transcranial Direct Current Stimulation |
title_short |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
title_full |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
title_fullStr |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
title_full_unstemmed |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
title_sort |
Precision non-implantable neuromodulation therapies: a perspective for the depressed brain |
author |
Borrione, Lucas |
author_facet |
Borrione, Lucas Bellini, Helena Razza, Lais Boralli Ávila, Ana G. Baeken, Chris Brem, Anna-Katharine Busatto, Geraldo Carvalho, Andre F. Chekroud, Adam Daskalakis, Zafiris J. Deng, Zhi-De Downar, Jonathan Gattaz, Wagner Loo, Colleen Lotufo, Paulo A Martin, Maria da Graça M. McClintock, Shawn M. O'Shea, Jacinta Padberg, Frank Passos, Ives C. Salum, Giovanni A. Vanderhasselt, Marie-Anne Fraguas, Renerio Benseñor, Isabela Valiengo, Leandro Brunoni, Andre R. |
author_role |
author |
author2 |
Bellini, Helena Razza, Lais Boralli Ávila, Ana G. Baeken, Chris Brem, Anna-Katharine Busatto, Geraldo Carvalho, Andre F. Chekroud, Adam Daskalakis, Zafiris J. Deng, Zhi-De Downar, Jonathan Gattaz, Wagner Loo, Colleen Lotufo, Paulo A Martin, Maria da Graça M. McClintock, Shawn M. O'Shea, Jacinta Padberg, Frank Passos, Ives C. Salum, Giovanni A. Vanderhasselt, Marie-Anne Fraguas, Renerio Benseñor, Isabela Valiengo, Leandro Brunoni, Andre R. |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Borrione, Lucas Bellini, Helena Razza, Lais Boralli Ávila, Ana G. Baeken, Chris Brem, Anna-Katharine Busatto, Geraldo Carvalho, Andre F. Chekroud, Adam Daskalakis, Zafiris J. Deng, Zhi-De Downar, Jonathan Gattaz, Wagner Loo, Colleen Lotufo, Paulo A Martin, Maria da Graça M. McClintock, Shawn M. O'Shea, Jacinta Padberg, Frank Passos, Ives C. Salum, Giovanni A. Vanderhasselt, Marie-Anne Fraguas, Renerio Benseñor, Isabela Valiengo, Leandro Brunoni, Andre R. |
dc.subject.por.fl_str_mv |
Major depressive disorder transcranial magnetic stimulation transcranial direct current stimulation electroconvulsive therapy precision medicine Brain Deep Brain Stimulation Depression Depressive Disorder, Major Humans Transcranial Magnetic Stimulation Treatment Outcome Electroconvulsive Therapy Transcranial Direct Current Stimulation |
topic |
Major depressive disorder transcranial magnetic stimulation transcranial direct current stimulation electroconvulsive therapy precision medicine Brain Deep Brain Stimulation Depression Depressive Disorder, Major Humans Transcranial Magnetic Stimulation Treatment Outcome Electroconvulsive Therapy Transcranial Direct Current Stimulation |
description |
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 non-implantable 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 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. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-08 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/105843 http://hdl.handle.net/10316/105843 https://doi.org/10.1590/1516-4446-2019-0741 |
url |
http://hdl.handle.net/10316/105843 https://doi.org/10.1590/1516-4446-2019-0741 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1809-452X 1516-4446 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Associacao Brasileira de Psiquiatria |
publisher.none.fl_str_mv |
Associacao Brasileira de Psiquiatria |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799134112870563840 |