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    Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting
    (Academia Brasileira de Neurologia - ABNEURO, 2010-06-01) Brunoni, André Russowsky; Teng, Chei Tung; Corrêa, Claudio Fernandes [UNIFESP]; Imamura, Marta; Brasil-Neto, Joaquim P; Boechat, Raphael; Rosa, Moacyr Alexandro [UNIFESP]; Caramelli, Paulo; Cohen, Roni; Porto, Jose Alberto Del [UNIFESP]; Boggio, Paulo Sergio; Fregni, Felipe; University of São Paulo Department and Institute of Psychiatry; Hospital 9 de Julho Pain Center and Functional Neurosurgery; University of Paulo Department of Physical Medicine and Rehabilitation; University of Brasília Laboratory of Neurosciences and Behavior; Columbia University; Federal University of Minas Gerais Faculty of Medicine Department of Internal Medicine (Neurology Unit); Centro Brasileiro de Estimulação Magnética; Universidade Federal de São Paulo (UNIFESP); University Mackenzie; Spaulding Rehabilitation Hospital Laboratory of Neuromodulation; Harvard Medical School; Berenson-Allen Center for Noninvasive Brain Stimulation; Harvard Medical School Beth Israel Deaconess Medical Center
    The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). METHOD: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. RESULTS: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. DISCUSSION: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches.