Eficácia da estimulação transcraniana por corrente contínua isolada ou associada a antidepressivos, psicoterapia ou terapias cognitivas para o tratamento da depressão maior - uma revisão de ensaios clínicos
DOI:
https://doi.org/10.33448/rsd-v10i15.22843Palavras-chave:
Transtorno depressivo; Estimulação transcraniana por corrente continua; Terapia combinada.Resumo
Considerando as evidências de que a estimulação transcraniana por corrente contínua (ETCC) é eficaz para o manejo da depressão maior (DM) e a perspectiva de incluir essa modalidade terapêutica entre os tratamentos convencionais, nosso principal objetivo foi avaliar a eficácia relatada da ETCC, combinada com antidepressivos, psicoterapia ou terapias cognitivas, em resultados clínicos e neuropsicológicos em pacientes com DM. Realizamos uma revisão integrativa de ensaios clínicos, orientada pela estratégia PICO, utilizando as bases de dados PubMed e Ovid MEDLINE®. Doze trabalhos científicos foram selecionados de acordo com critérios de inclusão e exclusão, analisados comparativamente, discutidos e teorizados. De acordo com esses estudos, a ETCC anódica aplicada ao córtex pré-frontal dorsolateral esquerdo exibe efeitos antidepressivos significativos, comparáveis à sertralina em baixas doses (50 mg/dia). Além disso, dois estudos principais indicam que os efeitos antidepressivos podem ser aumentados por tratamentos combinados, especialmente ETCC + sertralina. Também há evidências de um efeito sinérgico da ETCC e do treinamento de controle cognitivo, embora esse achado não seja unânime em diferentes abordagens metodológicas, e, portanto, requeira mais estudos para fundamentar a correlação entre a melhora neurocognitiva e clínica com esse tipo de terapia combinada. Por fim, efeitos cognitivos positivos induzidos por ETCC, principalmente na memória de trabalho, também foram verificados. Em conclusão, o pequeno número de trabalhos que empregam o ETCC associado a outras terapias mostra métodos de pesquisa muito discrepantes, bem como curtos períodos de acompanhamento, que, aliados ao baixo número de amostra, deixam muitas lacunas de conhecimento a serem respondidas em estudos futuros.
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