Efectividad de la estimulación transcraneal con corriente directa sola o en combinación con antidepresivos, psicoterapia o terapias cognitivas para el tratamiento de la depresión mayor - una revisión de ensayos clínicos
DOI:
https://doi.org/10.33448/rsd-v10i15.22843Palabras clave:
Transtono depresivo; Estimulación transcraneal de corriente directa; Terapia combinada.Resumen
Considerando la evidencia de que la estimulación transcraneal de corriente directa (ETCD) es efectiva para el manejo de la depresión mayor (DM) y la perspectiva de incluir esta modalidad terapéutica entre los tratamientos convencionales, nuestro principal objetivo fue evaluar la efectividad reportada de ETCD, combinada con antidepresivos, psicoterapia o terapias cognitivas, sobre los resultados clínicos y neuropsicológicos en pacientes con DM. Realizamos una revisión integradora de ensayos clínicos, guiados por la estrategia PICO, utilizando las bases de datos PubMed y Ovid MEDLINE®. Se seleccionaron doce trabajos científicos según criterios de inclusión y exclusión, analizados comparativamente, discutidos y teorizados. Según estos estudios, la tDCS anódica aplicada a la corteza prefrontal dorsolateral izquierda exhibe efectos antidepresivos significativos, comparables a la sertralina en dosis bajas (50 mg/día). Además, dos estudios principales indican que los efectos antidepresivos pueden incrementarse mediante tratamientos combinados, especialmente ETCD + sertralina. También hay evidencia de un efecto sinérgico de la tDCS y el entrenamiento de control cognitivo, aunque este hallazgo no es unánime en los diferentes enfoques metodológicos y, por lo tanto, requiere más estudios para corroborar la correlación entre la mejoría neurocognitiva y clínica con este tipo de terapia combinada. Finalmente, también se verificaron los efectos cognitivos positivos inducidos por ETCD, principalmente sobre la memoria de trabajo. En conclusión, el escaso número de estudios que utilizan ETCD asociado a otras terapias muestra métodos de investigación muy discrepantes, así como períodos de seguimiento cortos, que, combinados con el reducido tamaño de la muestra, dejan muchas lagunas de conocimiento por resolver en futuros estudios.
Citas
Arul-Anandam, A. P., & Loo, C. (2009). Transcranial direct current stimulation: a new tool for the treatment of depression? Journal of Affective Disorders, 117(3), 137–145. https://doi.org/10.1016/j.jad.2009.01.016
Association, A. P. (2014). Manual Diagnóstico e Estatístico de Transtornos Mentais (5 ed.). ARTMED.
Bennabi, D., Nicolier, M., Monnin, J., Tio, G., Pazart, L., Vandel, P., & Haffen, E. (2015). Pilot study of feasibility of the effect of treatment with tDCS in patients suffering from treatment-resistant depression treated with escitalopram. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 126(6), 1185–1189. https://doi.org/10.1016/j.clinph.2014.09.026
Berlim, M. T., Dias Neto, V., & Turecki, G. (2009). [Transcranial direct current stimulation: a promising alternative for the treatment of major depression?]. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999), 31 Suppl 1(Suppl I), S34-8. https://doi.org/10.1590/S1516-44462009000500006
Berti de Azevedo Barros, M. I., Guimarães Lima, M. I., Cruz Soares de Azevedo, R. I., Barbosa de Paula Medina III, L., de Souza Lopes, C. I., Rossi Menezes, P. V, Carvalho Malta, D. V., & A Barros Rua Tessália Vieira de Camargo, M. B. (2016). DESCRIPTORS: Depressive Disorder, epidemiology. Health Behavior. Health Knowledge, Attitudes, Practice. Health Surveys. 1–9. http://www.rsp.fsp.usp.br/2s
Bruder, G. E., Stewart, J. W., & McGrath, P. J. (2017). Right brain, left brain in depressive disorders: Clinical and theoretical implications of behavioral, electrophysiological and neuroimaging findings. Neuroscience and Biobehavioral Reviews, 78, 178–191. https://doi.org/10.1016/j.neubiorev.2017.04.021
Brunoni, A R, Boggio, P. S., De Raedt, R., Bensenor, I. M., Lotufo, P. A., Namur, V., Valiengo, L. C. L., & Vanderhasselt, M. A. (2014). Cognitive control therapy and transcranial direct current stimulation for depression: a randomized, double-blinded, controlled trial. Journal of Affective Disorders, 162, 43–49. https://doi.org/https://dx.doi.org/10.1016/j.jad.2014.03.026
Brunoni, Andre R, Moffa, A. H., Sampaio-Junior, B., Borrione, L., Moreno, M. L., Fernandes, R. A., Veronezi, B. P., Nogueira, B. S., Aparicio, L. V. M., Razza, L. B., Chamorro, R., Tort, L. C., Fraguas, R., Lotufo, P. A., Gattaz, W. F., Fregni, F., Bensenor, I. M., & Investigators, E.-T. (2017). Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression. The New England Journal of Medicine, 376(26), 2523–2533. https://doi.org/https://dx.doi.org/10.1056/NEJMoa1612999
Brunoni, Andre R, Valiengo, L., Baccaro, A., Zanao, T. A., de Oliveira, J. F., Goulart, A., Boggio, P. S., Lotufo, P. A., Bensenor, I. M., & Fregni, F. (2013). The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry, 70(4), 383–391. https://doi.org/https://dx.doi.org/10.1001/2013.jamapsychiatry.32
Brunoni, Andre Russowsky, Tortella, G., Bensenor, I. M., Lotufo, P. A., Carvalho, A. F., & Fregni, F. (2016). Cognitive effects of transcranial direct current stimulation in depression: Results from the SELECT-TDCS trial and insights for further clinical trials. Journal of Affective Disorders, 202, 46–52. https://doi.org/https://dx.doi.org/10.1016/j.jad.2016.03.066
Çakir, S., & Çağlar, N. (2017). Electroconvulsive Therapy in the Treatment of Mood Disorders: One-Year Follow-up. Noro Psikiyatri Arsivi, 54(3), 196–201. https://doi.org/10.5152/npa.2016.14845
Csifcsák, G., Boayue, N. M., Puonti, O., Thielscher, A., & Mittner, M. (2018). Effects of transcranial direct current stimulation for treating depression: A modeling study. Journal of Affective Disorders, 234, 164–173. https://doi.org/10.1016/j.jad.2018.02.077
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 58(7), 376–385. https://doi.org/10.1177/070674371305800702
Dean, J., & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian Journal of Psychiatry, 27, 101–111. https://doi.org/10.1016/j.ajp.2017.01.025
Dell’Osso, B., Dobrea, C., Arici, C., Benatti, B., Ferrucci, R., Vergari, M., Priori, A., & Altamura, A. C. (2014). Augmentative transcranial direct current stimulation (tDCS) in poor responder depressed patients: a follow-up study. CNS Spectrums, 19(4), 347–354. https://doi.org/https://dx.doi.org/10.1017/S1092852913000497
Depression-Global-Health-Estimates @ Www.Who.Int. (n.d.). https://www.who.int/publications/i/item/depression-global-health-estimates
Edwards, C. A., Kouzani, A., Lee, K. H., & Ross, E. K. (2017). Neurostimulation Devices for the Treatment of Neurologic Disorders. Mayo Clinic Proceedings, 92(9), 1427–1444. https://doi.org/10.1016/j.mayocp.2017.05.005
Fregni, F., El-Hagrassy, M. M., Pacheco-Barrios, K., Carvalho, S., Leite, J., Simis, M., Brunelin, J., Nakamura-Palacios, E. M., Marangolo, P., Venkatasubramanian, G., San-Juan, D., Caumo, W., Bikson, M., & Brunoni, A. R. (2020). Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation (tDCS) in neurological and psychiatric disorders. The International Journal of Neuropsychopharmacology. https://doi.org/10.1093/ijnp/pyaa051
Grimm, S., Beck, J., Schuepbach, D., Hell, D., Boesiger, P., Bermpohl, F., Niehaus, L., Boeker, H., & Northoff, G. (2008). Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biological Psychiatry, 63(4), 369–376. https://doi.org/10.1016/j.biopsych.2007.05.033
Hermida, A. P., Glass, O. M., Shafi, H., & McDonald, W. M. (2018). Electroconvulsive Therapy in Depression: Current Practice and Future Direction. The Psychiatric Clinics of North America, 41(3), 341–353. https://doi.org/10.1016/j.psc.2018.04.001
Hillhouse, T. M., & Porter, J. H. (2015). A brief history of the development of antidepressant drugs: from monoamines to glutamate. Experimental and Clinical Psychopharmacology, 23(1), 1–21. https://doi.org/10.1037/a0038550
Khayyer, Z., Ngaosuvan, L., Sikstrom, S., & Ghaderi, A. H. (2018). Transcranial direct current stimulation based on quantitative electroencephalogram combining positive psychotherapy for major depression. Journal of Integrative Neuroscience. https://doi.org/https://dx.doi.org/10.31083/JIN-170045
Kim, Y.-K., & Won, E. (2017). The influence of stress on neuroinflammation and alterations in brain structure and function in major depressive disorder. Behavioural Brain Research, 329, 6–11. https://doi.org/10.1016/j.bbr.2017.04.020
Kocmur, M., Milcinski, M., & Budihna, N. V. (1998). Evaluation of brain perfusion with technetium-99m bicisate single-photon emission tomography in patients with depressive disorder before and after drug treatment. European Journal of Nuclear Medicine, 25(10), 1412–1414. https://doi.org/10.1007/s002590050316
Koenigs, M., & Grafman, J. (2009). The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex. Behavioural Brain Research, 201(2), 239–243. https://doi.org/10.1016/j.bbr.2009.03.004
Koster, E. H. W., Hoorelbeke, K., Onraedt, T., Owens, M., & Derakshan, N. (2017). Cognitive control interventions for depression: A systematic review of findings from training studies. Clinical Psychology Review, 53, 79–92. https://doi.org/10.1016/j.cpr.2017.02.002
Lee, J. C., Lewis, C. P., Daskalakis, Z. J., & Croarkin, P. E. (2017). Transcranial Direct Current Stimulation: Considerations for Research in Adolescent Depression. Frontiers in Psychiatry, 8, 91. https://doi.org/10.3389/fpsyt.2017.00091
Lefaucheur, J.-P., Antal, A., Ayache, S. S., Benninger, D. H., Brunelin, J., Cogiamanian, F., Cotelli, M., De Ridder, D., Ferrucci, R., Langguth, B., Marangolo, P., Mylius, V., Nitsche, M. A., Padberg, F., Palm, U., Poulet, E., Priori, A., Rossi, S., Schecklmann, M., … Paulus, W. (2017). Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 128(1), 56–92. https://doi.org/10.1016/j.clinph.2016.10.087
Liu, W., Ge, T., Leng, Y., Pan, Z., Fan, J., Yang, W., & Cui, R. (2017). The Role of Neural Plasticity in Depression: From Hippocampus to Prefrontal Cortex. Neural Plasticity, 2017, 6871089. https://doi.org/10.1155/2017/6871089
López-López, J. A., Davies, S. R., Caldwell, D. M., Churchill, R., Peters, T. J., Tallon, D., Dawson, S., Wu, Q., Li, J., Taylor, A., Lewis, G., Kessler, D. S., Wiles, N., & Welton, N. J. (2019). The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis. Psychological Medicine, 49(12), 1937–1947. https://doi.org/10.1017/S003329171900120X
Mennen, A. C., Norman, K. A., & Turk-Browne, N. B. (2019). Attentional bias in depression: understanding mechanisms to improve training and treatment. Current Opinion in Psychology, 29, 266–273. https://doi.org/10.1016/j.copsyc.2019.07.036
Moreno, M. L., Goerigk, S. A., Bertola, L., Suemoto, C. K., Razza, L. B., Moffa, A. H., Veronezi, B. P., Tort, L., Nogueira, B. S., Gattaz, W. F., Fraguas, R., Padberg, F., Lotufo, P. A., Benseñor, I. M., & Brunoni, A. R. (2020). Cognitive changes after tDCS and escitalopram treatment in major depressive disorder: Results from the placebo-controlled ELECT-TDCS trial. Journal of Affective Disorders, 263, 344–352. https://doi.org/10.1016/j.jad.2019.12.009
Mottaghy, F. M., Keller, C. E., Gangitano, M., Ly, J., Thall, M., Parker, J. A., & Pascual-Leone, A. (2002). Correlation of cerebral blood flow and treatment effects of repetitive transcranial magnetic stimulation in depressed patients. Psychiatry Research, 115(1–2), 1–14. https://doi.org/10.1016/s0925-4927(02)00032-x
Nord, C. L., Halahakoon, D. C., Limbachya, T., Charpentier, C., Lally, N., Walsh, V., Leibowitz, J., Pilling, S., & Roiser, J. P. (2019). Neural predictors of treatment response to brain stimulation and psychological therapy in depression: a double-blind randomized controlled trial. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 44(9), 1613–1622. https://doi.org/https://dx.doi.org/10.1038/s41386-019-0401-0
Park, S., Choi, W.-J., Kim, S., Kim, B., Son, S. J., Roh, D., Kim, W. J., & Park, J. Y. (2020). Effects of transcranial direct current stimulation using miniaturized devices vs sertraline for depression in Korea: A 6 week, multicenter, randomized, double blind, active-controlled study. Journal of Psychiatric Research, 127, 42–47. https://doi.org/10.1016/j.jpsychires.2020.04.012
Pavlova, E. L., Menshikova, A. A., Semenov, R. V, Bocharnikova, E. N., Gotovtseva, G. N., Druzhkova, T. A., Gersamia, A. G., Gudkova, A. A., & Guekht, A. B. (2018). Transcranial direct current stimulation of 20- and 30-minutes combined with sertraline for the treatment of depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 82, 31–38. https://doi.org/https://dx.doi.org/10.1016/j.pnpbp.2017.12.004
Rahman, A., Lafon, B., Parra, L. C., & Bikson, M. (2017). Direct current stimulation boosts synaptic gain and cooperativity in vitro. The Journal of Physiology, 595(11), 3535–3547. https://doi.org/10.1113/JP273005
Sanchez, A., Vanderhasselt, M.-A., Baeken, C., & De Raedt, R. (2016). Effects of tDCS over the right DLPFC on attentional disengagement from positive and negative faces: An eye-tracking study. Cognitive, Affective & Behavioral Neuroscience, 16(6), 1027–1038. https://doi.org/10.3758/s13415-016-0450-3
Santoft, F., Axelsson, E., Öst, L.-G., Hedman-Lagerlöf, M., Fust, J., & Hedman-Lagerlöf, E. (2019). Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis. Psychological Medicine, 49(8), 1266–1274. https://doi.org/10.1017/S0033291718004208
Segrave, R. A., Arnold, S., Hoy, K., & Fitzgerald, P. B. (2014). Concurrent cognitive control training augments the antidepressant efficacy of tDCS: a pilot study. Brain Stimulation, 7(2), 325–331. https://doi.org/https://dx.doi.org/10.1016/j.brs.2013.12.008
Sharafi, E., Taghva, A., Arbabi, M., Dadarkhah, A., & Ghaderi, J. (2019). Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial. Clinical EEG and Neuroscience, 50(6), 375–382. https://doi.org/https://dx.doi.org/10.1177/1550059419863209
Swedish Council on Health Technology Assessment. (2004). Treatment of Depression: A Systematic Review.
Valiengo, L., Bensenor, I., Goulart, A., de Oliveira, J., Zanao, T., Boggio, P., Lotufo, P., Fregni, F., & Brunoni, A. (2013). THE SERTRALINE VERSUS ELECTRICAL CURRENT THERAPY FOR TREATING DEPRESSION CLINICAL STUDY (SELECT-TDCS): RESULTS OF THE CROSSOVER AND FOLLOW-UP PHASES. Depress. Anxiety, 30(7), 646–653. https://doi.org/10.1002/da.22079
Vanderhasselt, M.-A., De Raedt, R., Namur, V., Lotufo, P., Bensenor, I., Boggio, P., & Brunoni, A. (2015). Transcranial electric stimulation and neurocognitive training in clinically depressed patients: A pilot study of the effects on rumination. Prog. Neuro-Psychopharmacol. Biol. Psychiatry, 57, 93–99. https://doi.org/10.1016/j.pnpbp.2014.09.015
Vanderhasselt, M.-A., De Raedt, R., Namur, V., Valiengo, L. C. L., Lotufo, P. A., Bensenor, I. M., Baeken, C., Boggio, P. S., & Brunoni, A. R. (2016). Emotional reactivity to valence-loaded stimuli are related to treatment response of neurocognitive therapy. Journal of Affective Disorders, 190, 443–449. https://doi.org/https://dx.doi.org/10.1016/j.jad.2015.10.022
Welch, E., Weigand, A., Hooker, J., Philip, N., Tyrka, A., MD, P., Press, D., & Carpenter, L. (2019). Feasibility of Computerized Cognitive-Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression. Neuromodulation, 22(8), 898–903. https://doi.org/10.1111/ner.12807
Willner, P., Scheel-Krüger, J., & Belzung, C. (2013). The neurobiology of depression and antidepressant action. Neuroscience and Biobehavioral Reviews, 37(10 Pt 1), 2331–2371. https://doi.org/10.1016/j.neubiorev.2012.12.007
Wolkenstein, L., Zeiller, M., Kanske, P., & Plewnia, C. (2014). Induction of a depression-like negativity bias by cathodal transcranial direct current stimulation. Cortex; a Journal Devoted to the Study of the Nervous System and Behavior, 59, 103–112. https://doi.org/10.1016/j.cortex.2014.07.011
Zakhour, S., Nardi, A. E., Levitan, M., & Appolinario, J. C. (2020). Cognitive-behavioral therapy for treatment-resistant depression in adults and adolescents: a systematic review. Trends in Psychiatry and Psychotherapy, 42(1), 92–101. https://doi.org/10.1590/2237-6089-2019-0033
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2021 João Márcio Borgue de Oliveira; Thaís Hernandes Salmaso; Edvaldo José Rodrigues Cardoso; Silvia Graciela Ruginsk
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Los autores que publican en esta revista concuerdan con los siguientes términos:
1) Los autores mantienen los derechos de autor y conceden a la revista el derecho de primera publicación, con el trabajo simultáneamente licenciado bajo la Licencia Creative Commons Attribution que permite el compartir el trabajo con reconocimiento de la autoría y publicación inicial en esta revista.
2) Los autores tienen autorización para asumir contratos adicionales por separado, para distribución no exclusiva de la versión del trabajo publicada en esta revista (por ejemplo, publicar en repositorio institucional o como capítulo de libro), con reconocimiento de autoría y publicación inicial en esta revista.
3) Los autores tienen permiso y son estimulados a publicar y distribuir su trabajo en línea (por ejemplo, en repositorios institucionales o en su página personal) a cualquier punto antes o durante el proceso editorial, ya que esto puede generar cambios productivos, así como aumentar el impacto y la cita del trabajo publicado.