title: Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting.
abstract: The 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).
  
  
  METHODS
  We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  ECT 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.
authors.affiliation: Department and Institute of Psychiatry, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: André Russowsky
authors.initials: AR
authors.lastname: Brunoni
authors.forename: Chei Tung
authors.initials: CT
authors.lastname: Teng
authors.forename: Claudio
authors.initials: C
authors.lastname: Correa
authors.forename: Marta
authors.initials: M
authors.lastname: Imamura
authors.forename: Joaquim P
authors.initials: JP
authors.lastname: Brasil-Neto
authors.forename: Raphael
authors.initials: R
authors.lastname: Boechat
authors.forename: Moacyr
authors.initials: M
authors.lastname: Rosa
authors.forename: Paulo
authors.initials: P
authors.lastname: Caramelli
authors.forename: Roni
authors.initials: R
authors.lastname: Cohen
authors.forename: Jose Alberto
authors.initials: JA
authors.lastname: Del Porto
authors.forename: Paulo Sergio
authors.initials: PS
authors.lastname: Boggio
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D001938:Brazil; D046690:Deep Brain Stimulation / Q000379:methods; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055536:Vagus Nerve Stimulation / Q000379:methods