Clinical Application of Neurostimulation in Depression

  • Rafael C. R. Freire
  • Patricia C. Cirillo
  • Antonio E. Nardi


The neurostimulation techniques, such as electroconvulsive therapy (ECT), repeated transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), have been successfully used in the treatment of depressive disorders. The stimulation is focused on brain areas involved in major depressive disorder and produce symptom improvement, but it frequently affects other regions, producing unwanted effects. Studies indicate that neurostimulation methods with a narrow focus, like TMS, tend to be associated with less adverse events, compared to those with a broad focus, such as ECT. Bitemporal ECT is the most effective neurostimulation method, but it is also associated to higher risks and more side effects, compared to other methods. Compared to bitemporal ECT, there are fewer cognitive side effects with right unilateral and bifrontal ECT, but the effect size for these techniques is also reduced. TMS has been extensively studied, and currently it is considered a first-line treatment for treatment-resistant depressive disorders. High-quality studies with the other neurostimulation methods are still scant. Neurostimulation is a good alternative treatment for patients who did not achieve remission after several psychopharmacological treatments and psychotherapy. When deciding the best treatment for each patient, clinicians should take into account that, depending on the method, neurostimulation can have a very fast antidepressant effect or it could take many months to take effect. Risk and benefits of neurostimulation methods should also be weighted in each case.


Depressive disorder Electroconvulsive therapy Transcranial magnetic stimulation Magnetic seizure therapy Transcranial direct current stimulation Vagus nerve stimulation Deep brain stimulation 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Rafael C. R. Freire
    • 1
  • Patricia C. Cirillo
    • 1
  • Antonio E. Nardi
    • 1
  1. 1.Laboratory of Panic and Respiration, Institute of PsychiatryFederal University of Rio de JaneiroRio de JaneiroBrazil

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