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

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Abstract
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.
Keywords
Major depressive disorder, transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, precision medicine, TRANSCRANIAL MAGNETIC STIMULATION, DORSOLATERAL PREFRONTAL CORTEX, UNILATERAL ELECTROCONVULSIVE-THERAPY, 2016 CLINICAL GUIDELINES, ELECTRICAL-CURRENT THERAPY, BDNF BLOOD-LEVELS, MAJOR DEPRESSION, DOUBLE-BLIND, ANXIETY TREATMENTS, CANADIAN NETWORK

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MLA
Borrione, Lucas, et al. “Precision Non-Implantable Neuromodulation Therapies : A Perspective for the Depressed Brain.” BRAZILIAN JOURNAL OF PSYCHIATRY, vol. 42, no. 4, 2020, pp. 403–19, doi:10.1590/1516-4446-2019-0741.
APA
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. BRAZILIAN JOURNAL OF PSYCHIATRY, 42(4), 403–419. https://doi.org/10.1590/1516-4446-2019-0741
Chicago author-date
Borrione, Lucas, Helena Bellini, Lais Boralli Razza, Ana G. Avila, Chris Baeken, Anna-Katharine Brem, Geraldo Busatto, et al. 2020. “Precision Non-Implantable Neuromodulation Therapies : A Perspective for the Depressed Brain.” BRAZILIAN JOURNAL OF PSYCHIATRY 42 (4): 403–19. https://doi.org/10.1590/1516-4446-2019-0741.
Chicago author-date (all authors)
Borrione, Lucas, Helena Bellini, Lais Boralli Razza, Ana G. Avila, Chris Baeken, Anna-Katharine Brem, Geraldo Busatto, Andre F Carvalho, Adam Chekroud, Zafiris J Daskalakis, Zhi-De Deng, Jonathan Downar, Wagner Gattaz, Colleen Loo, Paulo A Lotufo, Maria da Graça M Martin, Shawn M McClintock, Jacinta O’Shea, Frank Padberg, Ives C Passos, Giovanni A Salum, Marie-Anne Vanderhasselt, Renerio Fraguas, Isabela Benseñor, Leandro Valiengo, and Andre R Brunoni. 2020. “Precision Non-Implantable Neuromodulation Therapies : A Perspective for the Depressed Brain.” BRAZILIAN JOURNAL OF PSYCHIATRY 42 (4): 403–419. doi:10.1590/1516-4446-2019-0741.
Vancouver
1.
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. BRAZILIAN JOURNAL OF PSYCHIATRY. 2020;42(4):403–19.
IEEE
[1]
L. Borrione et al., “Precision non-implantable neuromodulation therapies : a perspective for the depressed brain,” BRAZILIAN JOURNAL OF PSYCHIATRY, vol. 42, no. 4, pp. 403–419, 2020.
@article{8654829,
  abstract     = {{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.}},
  author       = {{Borrione, Lucas and Bellini, Helena and Razza, Lais Boralli and Avila, Ana G. and Baeken, Chris and Brem, Anna-Katharine and Busatto, Geraldo and Carvalho, Andre F and Chekroud, Adam and Daskalakis, Zafiris J and Deng, Zhi-De and Downar, Jonathan and Gattaz, Wagner and Loo, Colleen and Lotufo, Paulo A and Martin, Maria da Graça M and McClintock, Shawn M and O’Shea, Jacinta and Padberg, Frank and Passos, Ives C and Salum, Giovanni A and Vanderhasselt, Marie-Anne and Fraguas, Renerio and Benseñor, Isabela and Valiengo, Leandro and Brunoni, Andre R}},
  issn         = {{1516-4446}},
  journal      = {{BRAZILIAN JOURNAL OF PSYCHIATRY}},
  keywords     = {{Major depressive disorder,transcranial magnetic stimulation,transcranial direct current stimulation,electroconvulsive therapy,precision medicine,TRANSCRANIAL MAGNETIC STIMULATION,DORSOLATERAL PREFRONTAL CORTEX,UNILATERAL ELECTROCONVULSIVE-THERAPY,2016 CLINICAL GUIDELINES,ELECTRICAL-CURRENT THERAPY,BDNF BLOOD-LEVELS,MAJOR DEPRESSION,DOUBLE-BLIND,ANXIETY TREATMENTS,CANADIAN NETWORK}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{403--419}},
  title        = {{Precision non-implantable neuromodulation therapies : a perspective for the depressed brain}},
  url          = {{http://dx.doi.org/10.1590/1516-4446-2019-0741}},
  volume       = {{42}},
  year         = {{2020}},
}

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