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Clinical effectiveness of non-TMS neurostimulation in depression: Clinical trials from 2010 to 2020. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110287. [PMID: 33610609 DOI: 10.1016/j.pnpbp.2021.110287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Treatment for major depressive disorder (MDD) have evolved, although there is still a strong unmet need for more effective and tolerable options. The present study summarizes and discusses recent evidence regarding the non-transcranial magnetic stimulation (non-TMS) neurostimulation treatment for MDD. METHODS The authors reviewed non-TMS neurostimulation clinical trials for MDD between 2010 and 2020. Electroconvulsive therapy was not included in this review. A systematic review was performed in MEDLINE database through PubMed, the Cochrane Collaboration's Clinical Trials Register (CENTRAL), PsycINFO and Thomson Reuters's Web of Science. RESULTS Only 20 articles met the inclusion criteria. Randomized controlled trials demonstrated efficacy of transcranial direct current stimulation (tDCS) in five of seven trials. tDCS augmented with sertraline, fluoxetine, citalopram and escitalopram was superior to placebo and to tDCS only. A comparative trial demonstrated that the duration of tDCS sessions can modulate the effectiveness of this treatment. Open trials indicated that deep brain stimulation, epidural cortical stimulation, trigeminal nerve stimulation, magnetic seizure therapy and vagus nerve stimulation may be effective in treatment-resistant depression. CONCLUSION This review confirmed the efficacy of tDCS in MDD. Despite new evidence showing effectiveness for other non-TMS neurostimulation, their effectiveness is still unclear. Non-TMS neurostimulation RCTs with large samples and head-to-head studies comparing non-TMS neurostimulation and gold standard pharmacological treatments are still lacking.
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Cabrera LY, Nowak GR, McCright AM, Achtyes E, Bluhm R. A qualitative study of key stakeholders' perceived risks and benefits of psychiatric electroceutical interventions. HEALTH, RISK & SOCIETY 2021; 23:217-235. [PMID: 35574212 PMCID: PMC9103575 DOI: 10.1080/13698575.2021.1979194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Amid a renewed interest in alternatives to psychotherapy and medication to treat depression, there is limited data as to how different stakeholders perceive of the risks and benefits of psychiatric electroceutical interventions (PEIs), including electroconvulsive therapy (ECT) and deep brain stimulation (DBS). To address this gap, we conducted 48 semi-structured interviews, including 16 psychiatrists, 16 persons diagnosed with depression, and 16 members of the general public. To provide a basis of comparison, we asked participants to also compare each modality to front-line therapies for depression and to neurosurgical procedures used for non-psychiatric conditions. Across all stakeholder groups, perceived memory loss was the most frequently mentioned potential risk with ECT. The most discussed benefits across all stakeholder groups were efficacy and quick response. Psychiatrists most often referenced effectiveness when discussing ECT, while patients and the public did so when discussing DBS. Taken as a whole, these data highlight stakeholders' contrasting perspectives on the risks and benefits of electroceuticals.
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Affiliation(s)
- Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
- Rock Ethics Institute, Pennsylvania State University, University Park, PA, United States
| | - Gerald R Nowak
- Department of Sociology, Michigan State University, East Lansing, MI, United States
| | - Aaron M McCright
- Department of Sociology, Michigan State University, East Lansing, MI, United States
| | - Eric Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, East Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Robyn Bluhm
- Lyman Briggs College and Department of Philosophy, Michigan State University, East Lansing, MI, United States
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Razza LB, Afonso dos Santos L, Borrione L, Bellini H, Branco LC, Cretaz E, Duarte D, Ferrão Y, Galhardoni R, Quevedo J, Simis M, Fregni F, Correll CU, Padberg F, Trevizol A, Daskalakis ZJ, Carvalho AF, Solmi M, Brunoni AR. Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:514-524. [PMID: 33111776 PMCID: PMC8555652 DOI: 10.1590/1516-4446-2020-1169] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022]
Abstract
Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.
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Affiliation(s)
- Laís B. Razza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Leonardo Afonso dos Santos
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Lucas Borrione
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Helena Bellini
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil; HCFMUSP, Brazil
| | - Luis C. Branco
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Eric Cretaz
- Departamento e Instituto de Psiquiatria, HCFMUSP, Brazil
| | - Dante Duarte
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA; McMaster University, Canada
| | - Ygor Ferrão
- Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Ricardo Galhardoni
- Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), Brazil; Centro de Dor (LIM-62), Departamento de Neurologia, HCFMUSP, Brazil
| | - João Quevedo
- The University of Texas Health Science Center at Houston (UTHealth), USA; McGovern Medical School, USA; The University of Texas, MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, USA; Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Brazil
| | - Marcel Simis
- Instituto de Medicina Física e Reabilitação, HCFMUSP, Brazil
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Northwell Health, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA; Charité Universitätsmedizin Berlin, Germany
| | | | - Alisson Trevizol
- Centre for Addiction and Mental Health, Canada; University of Toronto, Canada
| | - Zafiris J. Daskalakis
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Andre F. Carvalho
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - André R. Brunoni
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil; HCFMUSP, Brazil; Departamento e Instituto de Psiquiatria, HCFMUSP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, HCFMUSP, Brazil
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Meir-Hasson Y, Kinreich S, Podlipsky I, Hendler T, Intrator N. An EEG Finger-Print of fMRI deep regional activation. Neuroimage 2014; 102 Pt 1:128-41. [DOI: 10.1016/j.neuroimage.2013.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 10/19/2013] [Accepted: 11/04/2013] [Indexed: 12/13/2022] Open
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The evidence-based practice of psychotherapy: facing the challenges that lie ahead. Clin Psychol Rev 2013; 33:813-24. [PMID: 23692739 DOI: 10.1016/j.cpr.2013.04.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 01/08/2023]
Abstract
What does the future hold for psychotherapy research and practice? We review some key influences, including declining psychotherapy utilization, increasing impact of evidence-based medical practices, over-medicalizing of mental health problems, and changing priorities from grant funding agencies. These factors hold potential opportunities but also major pitfalls that will need to be carefully navigated related to implementation/dissemination issues, interdisciplinary collaborations, and psychosocial versus biomedical perspectives related to the nature and treatment of psychopathology. In addition, we review and comment on the other articles contained in this special issue pertaining to the future of evidence-based psychotherapy.
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