A narrative review on invasive brain stimulation for treatment-resistant depression
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 stimulat...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Associação Brasileira de Psiquiatria (ABP)
2021-08-01
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| Series: | Brazilian Journal of Psychiatry |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462021005023201&tlng=en |
| _version_ | 1819282387390955520 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Manoj P. Dandekar |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-24T01:14:47Z |
| format | Article |
| id | doaj.art-2dd810023afa4f8a8c455cd74a86edc2 |
| institution | Directory Open Access Journal |
| issn | 1809-452X |
| language | English |
| last_indexed | 2024-12-24T01:14:47Z |
| publishDate | 2021-08-01 |
| publisher | Associação Brasileira de Psiquiatria (ABP) |
| record_format | Article |
| series | Brazilian Journal of Psychiatry |
| spelling | doaj.art-2dd810023afa4f8a8c455cd74a86edc22022-12-21T17:22:47ZengAssociação Brasileira de Psiquiatria (ABP)Brazilian Journal of Psychiatry1809-452X2021-08-0110.1590/1516-4446-2021-1874A narrative review on invasive brain stimulation for treatment-resistant depressionManoj P. DandekarAlexandre P. Diazhttps://orcid.org/0000-0002-6591-6648Ziaur RahmanRitele H. SilvaZiad NahasScott AaronsonSudhakar Selvarajhttps://orcid.org/0000-0002-9494-172XAlbert J. Fenoyhttps://orcid.org/0000-0002-9554-9885Marsal SanchesJair C. SoaresPatricio Riva-PosseJoao Quevedohttps://orcid.org/0000-0003-3114-6611While 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462021005023201&tlng=enTreatment-resistant depressiondeep brain stimulationvagus nerve stimulationepidural cortical stimulation subcallosal cingulate gyrusmedial forebrain bundle |
| spellingShingle | 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 A narrative review on invasive brain stimulation for treatment-resistant depression Brazilian Journal of Psychiatry Treatment-resistant depression deep brain stimulation vagus nerve stimulation epidural cortical stimulation subcallosal cingulate gyrus medial forebrain bundle |
| title | A narrative review on invasive brain stimulation for treatment-resistant depression |
| title_full | A narrative review on invasive brain stimulation for treatment-resistant depression |
| title_fullStr | A narrative review on invasive brain stimulation for treatment-resistant depression |
| title_full_unstemmed | A narrative review on invasive brain stimulation for treatment-resistant depression |
| title_short | A narrative review on invasive brain stimulation for treatment-resistant depression |
| title_sort | narrative review on invasive brain stimulation for treatment resistant depression |
| topic | Treatment-resistant depression deep brain stimulation vagus nerve stimulation epidural cortical stimulation subcallosal cingulate gyrus medial forebrain bundle |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462021005023201&tlng=en |
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