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

Arq Neuropsiquiatr. 2010 Jun;68(3):433-51. doi: 10.1590/s0004-282x2010000300021.

Abstract

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.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Brazil
  • Deep Brain Stimulation / methods
  • Depressive Disorder, Major / physiopathology
  • Depressive Disorder, Major / therapy*
  • Electric Stimulation Therapy / methods*
  • Electroconvulsive Therapy / methods*
  • Humans
  • Psychiatric Status Rating Scales
  • Transcranial Magnetic Stimulation / methods*
  • Vagus Nerve Stimulation / methods