RESUMEN
Trends in brain stimulation include becoming less invasive, more focal, and more durable with less toxicity. Several of the more interesting new potentially disruptive technologies that are just making their way through basic and sometimes clinical research studies include low-intensity focused ultrasound and temporally interfering electric fields. It is possible, and even likely, that noninvasive brain stimulation may become the dominant form of brain treatments over the next 20 years. The future of brain stimulation therapeutics is bright.
Asunto(s)
Encéfalo , Terapia por Estimulación Eléctrica/métodos , Terapia Electroconvulsiva/métodos , Trastornos Mentales/terapia , Terapias Somáticas Psiquiátricas/métodos , Estimulación Magnética Transcraneal/métodos , Terapia por Ultrasonido/métodos , Encéfalo/fisiopatología , Terapia por Estimulación Eléctrica/normas , Terapia por Estimulación Eléctrica/tendencias , Terapia Electroconvulsiva/normas , Terapia Electroconvulsiva/tendencias , Humanos , Terapias Somáticas Psiquiátricas/normas , Terapias Somáticas Psiquiátricas/tendencias , Estimulación Magnética Transcraneal/normas , Estimulación Magnética Transcraneal/tendencias , Terapia por Ultrasonido/normas , Terapia por Ultrasonido/tendenciasRESUMEN
A significant proportion of depressed patients eventually present with treatment-resistant/refractory major depression (TRD), a debilitating condition that imposes significant health, social, and economic burdens. Recently, a growing level of consensus has been reached on the general meaning of TRD, according to which, depression is considered resistant when at least two trials with antidepressants from different pharmacologic classes (adequate in terms of dose, duration, outcome, and compliance) failed to achieve clinical remission. Regarding the management of TRD, a two-step approach is suggested, involving first the evaluation of factors that may contribute to treatment nonresponse (such as comorbid medical and psychiatric conditions), and second, the use of the four classical strategies for enhancing antidepressant efficacy (namely optimization, augmentation, combination, and switching). Finally, future research on TRD should include studies addressing, among other issues, the validity of the proposed definitional criteria, the evaluation of reliable predictors of treatment outcome, and the development of novel therapeutic strategies.
