ppraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trial

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Razza, Lais B. ^[1] ; dos Santos, Leonardo Afonso ^[1] ; Borrione, Lucas ^[1] ; Bellini, Helena ^{[1, 2]} ; Branco, Luis C. ^[3] ; Cretaz, Eric ^[4] ; Duarte, Dante ^{[5, 3]} ; Ferrao, Ygor ^[6] ; Galhardoni, Ricardo ^{[7, 8]} ; Quevedo, Joao ^{[9, 10, 11, 12]} ; Simis, Marcel ^[13] ; Fregni, Felipe ^{[14, 15]} ; Correll, Christoph U. ^{[16, 17, 18]} ; Padberg, Frank ^[19] ; Trevizol, Alisson ^{[20, 21]} ; Daskalakis, Zafiris J. ^{[20, 22]} ; Carvalho, Andre F. ^{[20, 22]} ; Solmi, Marco ^[23] ; Brunoni, Andre R. ^{[1, 24, 25, 26]}

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^[1] Univ Sao Paulo HCFMUSP, Dept & Inst Psiquiatria, Serv Interdisciplinar Neuromodulacao, Lab Neurociencias LIM27, Hosp Clin, Fac Med, Sao Paulo, SP - Brazil

^[2] HCFMUSP, Lab Neuroimagem Psiquiatria LIM21, Dept & Inst Psiquiatria, Sao Paulo, SP - Brazil

^[3] Harvard Med Sch, Neuromodulat & Clin Res Ctr, Spaulding Rehabil Hosp, Boston, MA 02115 - USA

^[4] HCFMUSP, Serv Eletroconvulsoterapia, Dept & Inst Psiquiatria, Sao Paulo, SP - Brazil

^[5] McMaster Univ, Dept Psychiat & Behav Neurosci, Hamilton, ON - Canada

^[6] Univ Fed Ciencias Saude Porto Alegre UFCSPA, Dept Clin Med, Porto Alegre, RS - Brazil

^[7] Univ Cidade Sao Paulo UNICID, Fac Med, Sao Paulo, SP - Brazil

^[8] HCFMUSP, Dept Neurol, Ctr Dor LIM 62, Sao Paulo, SP - Brazil

^[9] Univ Texas Hlth Sci Ctr Houston UTHlth, McGovern Med Sch, Faillace Dept Psychiat & Behav Sci, Translat Psychiat Program, Houston, TX - USA

^[10] UTHlth, McGovern Med Sch, Faillace Dept Psychiat & Behav Sci, Ctr Excellence Mood Disorders, Houston, TX - USA

^[11] Univ Texas MD Anderson Canc Ctr, Neurosci Grad Program, UTHlth Grad Sch Biomed Sci, Houston, TX 77030 - USA

^[12] Univ Extremo Sul Catarinense UNESC, Lab Psiquiatria Translac, Programa Posgrad Ciencias Saude, Criciuma, SC - Brazil

^[13] HCFMUSP, Inst Med Fis & Reabilitacao, Sao Paulo, SP - Brazil

^[14] Harvard Med Sch, Lab Neuromodulat, Boston, MA 02115 - USA

^[15] Harvard Med Sch, Ctr Clin Res Learning, Dept Phys Med & Rehabil, Spaulding Rehabil Hosp, Boston, MA 02115 - USA

^[16] Northwell Hlth, Dept Psychiat, Zucker Hillside Hosp, Glen Oaks, NY - USA

^[17] Hofstra Northwell, Donald & Barbara Zucker Sch Med, Dept Psychiatty & Mol Med, Hempstead, NY - USA

^[18] Charite Univ Med Berlin, Dept Child & Adolescent Psychiat, Berlin - Germany

^[19] Ludwig Maximilian Univ Munich, Dept Psychiat & Psychotherapy, Munich - Germany

^[20] Univ Toronto, Dept Psychiat, Toronto, ON - Canada

^[21] Ctr Addict & Mental Hlth, Temerty Ctr Therapeut Brain Intervent, Toronto, ON - Canada

^[22] Ctr Addict & Mental Hlth CAMH, Toronto, ON - Canada

^[23] Univ Padua, Dipartimento Neurosci, Padua - Italy

^[24] HCFMUSP, Sao Paulo, SP - Brazil

^[25] HCFMUSP, Lab Neurociencias LIM27, Dept & Inst Psiquiatria, Sao Paulo, SP - Brazil

^[26] HCFMUSP, Dept & Inst Psiquiatria, Inst Nacl Biomarcadores Neuropsiquiatria INBioN, Sao Paulo, SP - Brazil

• Tipo de documento: Artigo de Revisão
• Fonte: Revista Brasileira de Psiquiatria; v. 43, n. 5, p. 514-524, SEP-OCT 2021.
• Citações Web of Science: 6

Resumo

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles. (AU)

• Processo FAPESP: 19/07256-7 - Alterações na perfusão cerebral induzidas por estimulação transcraniana do córtex pré-frontal: um estudo randomizado, placebo-controlado utilizando 99mTc SPECT
• Beneficiário: Lais Boralli Razza
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto