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Precision non-implantable neuromodulation therapies: a perspective for the depressed brain.

Publication ,  Journal Article
Borrione, L; Bellini, H; Razza, LB; Avila, AG; Baeken, C; Brem, A-K; Busatto, G; Carvalho, AF; Chekroud, A; Daskalakis, ZJ; Deng, Z-D; Loo, C ...
Published in: Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)
August 2020

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.

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Published In

Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)

DOI

EISSN

1809-452X

ISSN

1516-4446

Publication Date

August 2020

Volume

42

Issue

4

Start / End Page

403 / 419

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Transcranial Direct Current Stimulation
  • Psychiatry
  • Humans
  • Electroconvulsive Therapy
  • Depressive Disorder, Major
  • Depression
  • Deep Brain Stimulation
  • Brain
 

Citation

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Borrione, L., Bellini, H., Razza, L. B., Avila, A. G., Baeken, C., Brem, A.-K., … Brunoni, A. R. (2020). Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999), 42(4), 403–419. https://doi.org/10.1590/1516-4446-2019-0741
Borrione, Lucas, Helena Bellini, Lais Boralli Razza, Ana G. Avila, Chris Baeken, Anna-Katharine Brem, Geraldo Busatto, et al. “Precision non-implantable neuromodulation therapies: a perspective for the depressed brain.Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999) 42, no. 4 (August 2020): 403–19. https://doi.org/10.1590/1516-4446-2019-0741.
Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem A-K, et al. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2020 Aug;42(4):403–19.
Borrione, Lucas, et al. “Precision non-implantable neuromodulation therapies: a perspective for the depressed brain.Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999), vol. 42, no. 4, Aug. 2020, pp. 403–19. Epmc, doi:10.1590/1516-4446-2019-0741.
Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem A-K, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng Z-D, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O’Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt M-A, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2020 Aug;42(4):403–419.

Published In

Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)

DOI

EISSN

1809-452X

ISSN

1516-4446

Publication Date

August 2020

Volume

42

Issue

4

Start / End Page

403 / 419

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Transcranial Direct Current Stimulation
  • Psychiatry
  • Humans
  • Electroconvulsive Therapy
  • Depressive Disorder, Major
  • Depression
  • Deep Brain Stimulation
  • Brain