Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review

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Rosson, Stella ; de Filippis, Renato ; Croatto, Giovanni ; Collantoni, Enrico ; Pallottino, Simone ; Guinart, Daniel ; Brunoni, Andre R. ; Dell'Osso, Bernardo ; Pigato, Giorgio ; Hyde, Joshua ; Brandt, Valerie ; Cortese, Samuele ; Fiedorowicz, Jess G. ; Petrides, Georgios ; Correll, Christoph U. ; Solmi, Marco

• Tipo de documento: Artigo Científico
• Fonte: NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS; v. 139, p. 18-pg., 2022-06-27.

Resumo

Background: The degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear. Methods: We conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE. Results: We selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRA-DE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRA-DE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No sig-nificant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high -quality meta-analyses/low-quality RCTs), GRADE low. Discussion: Despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines. Funding: None. (AU)

• Processo FAPESP: 19/06009-6 - Terapias de neuromodulação não-implantáveis: uma perspectiva para o cérebro deprimido
• Beneficiário: Andre Russowsky Brunoni
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 18/10861-7 - Avaliação multimodal dos efeitos da estimulação transcraniana por corrente contínua e estimulação theta-burst no funcionamento do córtex pré-frontal: um estudo Fase-I bilateral, placebo-controlado, fatorial
• Beneficiário: Andre Russowsky Brunoni
• Modalidade de apoio: Auxílio à Pesquisa - Regular