A narrative review on invasive brain stimulation for treatment-resistant depression
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
;
44(3): 317-330, May-June 2022. tab, graf
Article
in English
|
LILACS-Express
| LILACS
| ID: biblio-1374608
ABSTRACT
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.
Full text:
Available
Index:
LILACS (Americas)
Type of study:
Controlled clinical trial
/
Prognostic study
Language:
English
Journal:
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
Journal subject:
Psychiatry
Year:
2022
Type:
Article
/
Project document
Affiliation country:
Brazil
/
India
/
United States
Institution/Affiliation country:
Clinical Research Programs, Sheppard Pratt Health System/US
/
Emory University/US
/
National Institute of Pharmaceutical Education and Research/IN
/
The University of Texas Health Science Center at Houston (UTHealth)/US
/
Universidade do Extremo Sul Catarinense (UNESC)/BR
/
University of Minnesota/US
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