• André Russowsky Brunoni, Chei Tung Teng, Claudio Correa, Marta Imamura, Joaquim P Brasil-Neto, Raphael Boechat, Moacyr Rosa, Paulo Caramelli, Roni Cohen, Jose Alberto Del Porto, Paulo Sergio Boggio, and Felipe Fregni.
• Department and Institute of Psychiatry, University of São Paulo, São Paulo, SP, Brazil.
• Arq Neuropsiquiatr. 2010 Jun 1; 68 (3): 433-51.

UnlabelledThe use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS).MethodWe convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD.ResultsThe state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them.DiscussionECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches.

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