REVIEW
Introdução: A depressão resistente ou refratária ao tratamento (TRD) é uma das condições mais desafiadoras da medicina no campo da psiquiatria. Ela é conceituada como a não resposta ou melhora clínica em casos com uso de uma ou duas classes de antidepressivos, por um período maior que um mês. A etiologia ainda não foi totalmente esclarecida e pode estar associada a uma multiplicidade de fatores. Objetivo: Mapear e compreender a eficácia e segurança da estimulação cerebral profunda (DBS) como uma opção terapêutica para a depressão refratária. Métodos: Trata-se de uma revisão sistemática da literatura guiada pela estratégia PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), com buscas realizadas nas bases de dados Medline/Pubmed, Portal BVS e Cochrane Library. Os descritores combinados com os operadores booleanos “AND” e “OR” foram: “deep brain stimulation”, “treatment-resistant depression”, “efficacy” e “safety”. Foram incluídos ensaios clínicos randomizados, publicados nos idiomas inglês, português ou espanhol e que responderam à questão de pesquisa. Os resultados analisados incluíram taxas de resposta, remissão e principais eventos adversos (EAs), com foco na ideação suicida, tentativas de suicídio e suicídio consumado. Houve registro do protocolo no PROSPERO (CRD42024516453). Resultados: Foram incluídos 14 artigos, com uma média de 18,73 ± 21,8 pacientes, totalizando uma amostra de 231 pacientes. Foram analisados 4 alvos anatômicos e parâmetros variáveis para DBS. A eficácia foi indicada pelas taxas de resposta (variando de 20% a 100%) e pelas taxas de remissão (variando de 20% a 80%) que, embora sejam contrastantes, indicam o avanço entre os diversos parâmetros utilizados. Além disso, os EAs também variaram, tendo como principais eventos, a ideação suicida, a tentativa de suicidio e a consumação do suicídio. Os demais EAs foram geralmente leves e passíveis de controle. No entanto, as taxas de ideação suicida, tentativas de suicídio e suicídio não devem ser ignoradas. Conclusão: Os indicadores demonstram que a estimulação cerebral profunda constitui um tratamento promissor para a TRD, a depender dos alvos e parâmetros anatômicos explorados, muito embora os EAs não devam ser negligenciados. Desta forma, estudos posteriores deverão determinar alvos terapêuticos mais adequados e o melhor perfil de paciente a ser beneficiado pela terapia e, com isso, elevar as taxas de eficácia e segurança, bem como reduzir os EAs.
Introduction: Treatment-resistant or refractory depression (TRD) is one of the most challenging conditions in the field of psychiatry. It is conceptualized as the lack of response or clinical improvement when using one or two classes of antidepressants, for a period longer than one month. The etiology has not yet been fully clarified and may be associated with a multitude of factors. Objective: To map and understand the efficacy and safety of Deep Brain Stimulation (DBS) as a therapeutic option for refractory depression. Methods: This is a systematic review of the literature guided by the PRISMA 2020 strategy (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), with searches carried out in the Medline/Pubmed, VHL Portal and Cochrane Library databases. The descriptors combined with the Boolean operators “AND” and “OR” were: “deep brain stimulation”, “treatment-resistant depression”, “efficacy” and “safety”. Randomized clinical trials were included, published in English, Portuguese or Spanish which answered the research question. The results analyzed included response rates, remission and main adverse events (AEs), focusing on suicidal ideation, suicide attempts and completed suicide. The protocol was registered in PROSPERO (CRD42024516453). Results: 14 articles were included, with an average of 18.73 ± 21.8 patients, totaling a sample of 231 patients. Four anatomical targets and variable parameters for DBS were analyzed. Efficacy was indicated by response rates (ranging from 20% to 100%) and remission rates (ranging from 20% to 80%) which, although contrasting, indicate progress among the various parameters used. In addition, the AEs also varied, with the main events being suicidal ideation, suicide attempt and suicide completion. The other AEs were generally mild and controllable. However, rates of suicidal ideation, suicide attempts and suicide should not be ignored. Conclusion: The indicators show that Deep Brain Stimulation constitutes a promising treatment for TRD, depending on the anatomical targets and parameters explored, although AEs should not be neglected. Thus, further studies should determine more suitable therapeutic targets and the best patient profile to be benefited from therapy and, with this, increase efficacy and safety rates, as well as reduce AEs.
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1MS, Medical student, Universidade Federal de Juiz de Fora – UFJF, Juiz de Fora, MG, Brasil.
2MS, Medical student, Universidade Federal do Ceará – UFC, Fortaleza, CE, Brasil.
3MS, Medical student, Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brasil.
4MS, Medical student, Universidade Federal do Tocantins – UFT, Palmas, TO, Brasil.
5MS, Medical student, Universidade Nove de Julho, São Bernardo do Campo, SP, Brasil.
6MD, Preceptor, Neurosurgery Residency Program, Neurosurgery Service, Hospital do Rocio, Campo Largo, PR, Brasil.
7MD, MSc, Neurosurgeon, Supervisor, Neurosurgery Residency Program, Neurosurgery Service, Hospital do Rocio, Campo Largo, PR, Brasil.
8MD, MSc, Neurosurgeon, Head of Neurosurgery Service, Hospital do Rocio, Campo Largo, PR, Brasil.
Received May 1, 2024
Accepted May 27, 2024
