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

• Autor(a) principal: Brunoni, André Russowsky
• Data de Publicação: 2010
• Outros Autores: Teng, Chei Tung, Corrêa, Claudio Fernandes [UNIFESP], Imamura, Marta, Brasil-Neto, Joaquim P, Boechat, Raphael, Rosa, Moacyr Alexandro [UNIFESP], Caramelli, Paulo, Cohen, Roni, Porto, Jose Alberto Del [UNIFESP], Boggio, Paulo Sergio, Fregni, Felipe
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0004-282X2010000300021; http://repositorio.unifesp.br/handle/11600/5743
• topic: comprehensive review; major depressive disorder; ECT; TMS; clinical guidelines; artigo de revisão; transtorno depressivo maior; eletroconvulsoterapia; estimulação magnética transcraniana; recomendações para a prática clínica

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.