A narrative review on invasive brain stimulation for treatment-resistant depression
| Autor: | Manoj P. Dandekar, Alexandre P. Diaz, Ziaur Rahman, Ritele H. Silva, Ziad Nahas, Scott Aaronson, Sudhakar Selvaraj, Albert J. Fenoy, Marsal Sanches, Jair C. Soares, Patricio Riva-Posse, Joao Quevedo |
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| Jazyk: | English<br />Portuguese |
| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Brazilian Journal of Psychiatry (2021) |
| Druh dokumentu: | article |
| ISSN: | 1809-452X 1516-4446 |
| DOI: | 10.1590/1516-4446-2021-1874 |
| Popis: | 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. |
| Databáze: | Directory of Open Access Journals |
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