Álex Brunno do Nascimento Martins, Bárbara Rodrigues Alvernaz dos Santos, Elder Gomes Pereira, Luana Oliveira Prata, Maiara Silva Araujo, Roberto Lúcio Muniz Júnior, Ursula Carolina de Morais Martins, Augusto Afonso Guerra Júnior, Francisco de Assis Acúrcio, Juliana Álvares Teodoro
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引用次数: 0
Abstract
Introduction
Depression is a general term that describes different depressive disorders which are highly prevalent and disabling, characterized by decreases in quality of life. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain modulation technique used, among other purposes, for the treatment of chronic pain and headache. In order to clarify the effect of this stimulation on depressive disorders, the objective of this review was to evaluate efficacy and safety of treatment with tDCS for depressive disorders.
Methods
A systematic research study was carried out on 30 June 2022 in MEDLINE (by Pubmed), Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PsycInfo e Global Mental Health databases. Were included systematic reviews (SR) with meta-analysis that selected patients with depression, in use of tDCS, using as comparator sham stimulation (placebo) or any other treatment (pharmacologic or no) or any comparison between pre-and post-intervention.
Results
Eight SR with meta-analysis of randomized clinical trials (RCTs) on the efficacy and safety of tDCS in the treatment of depressive disorders were retrieved. Subjects were assessed for clinical response, remission, change in scores on depression scales, occurrence of procedure-related adverse events, and treatment dropout. Three systematic reviews showed results that point to the effectiveness of tDCS for the clinical response outcome and one considering the remission outcome. As for the outcome measured by the change in depression scale scores, all included reviews showed favorable results for tDCS. It is noteworthy that the studies included in the reviews have methodological limitations. With regard to safety, an increased risk treatment-emergent mania or hypomania (TEM) has been observed.
Conclusions
The tDCS association with antidepressants showed favorable results to this technology in a sample with depression and varied clinical characteristics. Regarding safety of this technology, tDCS did not show adverse effects of greater severity, but was verified to have an increased risk of TEM.
抑郁症是一个通用术语，描述了各种高度流行和致残的抑郁症，其特征是生活质量下降。经颅直流电刺激(tDCS)是一种非侵入性脑调节技术，除其他目的外，用于治疗慢性疼痛和头痛。为了阐明这种刺激对抑郁症的影响，本综述的目的是评估tDCS治疗抑郁症的有效性和安全性。方法于2022年6月30日在MEDLINE (Pubmed)、Embase、Literatura latin - americana e do Caribe em Ciências da Saúde (LILACS)、PsycInfo和Global Mental Health数据库中进行系统研究。纳入系统评价(SR)和荟萃分析，选择抑郁症患者，使用tDCS，作为对照，使用假刺激(安慰剂)或任何其他治疗(药物或无)或干预前后的任何比较。结果对tDCS治疗抑郁症的疗效和安全性随机临床试验(rct)进行meta分析。评估受试者的临床反应、缓解、抑郁量表评分的变化、手术相关不良事件的发生和治疗退出。三个系统综述的结果表明tDCS对临床反应结果的有效性，一个考虑缓解结果。至于抑郁量表得分变化所衡量的结果，所有纳入的综述均显示tDCS效果良好。值得注意的是，纳入综述的研究存在方法学上的局限性。在安全性方面，观察到出现的躁狂或轻躁狂(TEM)风险增加。结论tDCS与抗抑郁药物的关联在具有不同临床特征的抑郁症患者中显示出良好的效果。关于这项技术的安全性，tDCS没有显示出更严重的不良影响，但被证实有增加TEM的风险。
期刊介绍：
International Journal of Technology Assessment in Health Care serves as a forum for the wide range of health policy makers and professionals interested in the economic, social, ethical, medical and public health implications of health technology. It covers the development, evaluation, diffusion and use of health technology, as well as its impact on the organization and management of health care systems and public health. In addition to general essays and research reports, regular columns on technology assessment reports and thematic sections are published.
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