TY - JOUR
T1 - Precision non-implantable neuromodulation therapies
T2 - A perspective for the depressed brain
AU - Borrione, Lucas
AU - Bellini, Helena
AU - Razza, Lais Boralli
AU - Avila, Ana G.
AU - Baeken, Chris
AU - Brem, Anna Katharine
AU - Busatto, Geraldo
AU - Carvalho, Andre F.
AU - Chekroud, Adam
AU - Daskalakis, Zafiris J.
AU - Deng, Zhi De
AU - Downar, Jonathan
AU - Gattaz, Wagner
AU - Loo, Colleen
AU - Lotufo, Paulo A.
AU - Martin, Maria da Graça M.
AU - McClintock, Shawn M.
AU - O’shea, Jacinta
AU - Padberg, Frank
AU - Passos, Ives C.
AU - Salum, Giovanni A.
AU - Vanderhasselt, Marie Anne
AU - Fraguas, Renerio
AU - Benseñor, Isabela
AU - Valiengo, Leandro
AU - Brunoni, Andre R.
N1 - Publisher Copyright:
© 2020, Associacao Brasileira de Psiquiatria. All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ‘‘precision-oriented’’ practice.
AB - Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ‘‘precision-oriented’’ practice.
KW - Electroconvulsive therapy
KW - Major depressive disorder
KW - Precision medicine
KW - Transcranial direct current stimulation
KW - Transcranial magnetic stimulation
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U2 - 10.1590/1516-4446-2019-0741
DO - 10.1590/1516-4446-2019-0741
M3 - Article
C2 - 32187319
AN - SCOPUS:85083742279
SN - 1516-4446
VL - 42
SP - 403
EP - 419
JO - Revista Brasileira de Psiquiatria
JF - Revista Brasileira de Psiquiatria
IS - 4
ER -