TY - JOUR
T1 - A narrative review on invasive brain stimulation for treatment-resistant depression
AU - Dandekar, Manoj P.
AU - Diaz, Alexandre P.
AU - Rahman, Ziaur
AU - Silva, Ritele H.
AU - Nahas, Ziad
AU - Aaronson, Scott
AU - Selvaraj, Sudhakar
AU - Fenoy, Albert J.
AU - Sanches, Marsal
AU - Soares, Jair C.
AU - Riva-Posse, Patricio
AU - Quevedo, Joao
N1 - Publisher Copyright:
© 2022, Associacao Brasileira de Psiquiatria. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - 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 (4 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, inferiorthalamic 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.
AB - 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 (4 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, inferiorthalamic 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.
KW - Treatment-resistant depression
KW - deep brain stimulation
KW - epidural cortical stimulation subcallosal cingulate gyrus
KW - medial forebrain bundle
KW - vagus nerve stimulation
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U2 - 10.1590/1516-4446-2021-1874
DO - 10.1590/1516-4446-2021-1874
M3 - Article
C2 - 34468549
AN - SCOPUS:85122310469
SN - 1516-4446
VL - 44
SP - 317
EP - 330
JO - Revista Brasileira de Psiquiatria
JF - Revista Brasileira de Psiquiatria
IS - 3
ER -