Precision non-implantable neuromodulation therapies: a perspective for the depressed brain
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
;
42(4): 403-419, July-Aug. 2020. graf
Article
in English
| LILACS
| ID: biblio-1132110
ABSTRACT
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.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Deep Brain Stimulation
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Depression
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Depressive Disorder, Major
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Electroconvulsive Therapy
Language:
English
Journal:
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
Journal subject:
Psychiatry
Year:
2020
Type:
Article
Affiliation country:
Australia
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Belgium
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Brazil
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Canada
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Germany
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Portugal
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United States
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United kingdom
Institution/Affiliation country:
Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP/BR
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Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP)/BR
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Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto/CA
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Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra/PT
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Ghent University/BE
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Hospital Universitário, USP/BR
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Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP/BR
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Max Planck Institute of Psychiatry/DE
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National Institute of Mental Health, National Institutes of Health/US
/
Porto Alegre/BR
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