Comentários:

Dr. Paulo de Mello
Coordenador do GEPECH – Grupo de Estudos e Pesquisa em Comportamento Humano (CEMCO/UNIFESP)

The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder.

Perera T1, George MS2, Grammer G3, Janicak PG4, Pascual-Leone A5, Wirecki TS6.

Abstract

BACKGROUND:

Prefrontal Transcranial Magnetic Stimulation (TMS) therapy repeated daily over 4-6 weeks (20-30 sessions) is US Food and Drug Administration (FDA) approved for treating Major Depressive Disorder in adults who have not responded to prior antidepressant medications. In 2011, leading TMS clinical providers and researchers created the Clinical TMS Society (cTMSs) (www.clinicaltmssociety.org, Greenwich, CT, USA), incorporated in 2013.

METHODS:

This consensus review was written by cTMSs leaders, informed by membership polls, and approved by the governing board. It summarizes current evidence for the safety and efficacy of the use of TMS therapy for treating depression in routine clinical practice. Authors systematically reviewed the published TMS antidepressant therapy clinical trials. Studies were then assessed and graded on their strength of evidence using the Levels of Evidence framework published by the University of Oxford Centre for Evidence Based Medicine. The authors then summarize essentials for using TMS therapy in routine clinical practice settings derived from discussions and polls of cTMSs members. Finally, each summary clinical recommendation is presented with the substantiating peer-reviewed, published evidence supporting that recommendation. When the current published clinical trial evidence was insufficient or incomplete, expert opinion was included when sufficient consensus was available from experienced clinician users among the membership of the cTMSs, who were polled at the Annual Meetings in 2014 and 2015.

CONCLUSIONS:

Daily left prefrontal TMS has substantial evidence of efficacy and safety for treating the acute phase of depression in patients who are treatment resistant or intolerant. Following the clinical recommendations in this document should result in continued safe and effective use of this exciting new treatment modality.

Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Depression; Guidelines; Review; TMS
Fonte: Brain Stimul. 2016 May-Jun;9(3):336-346. doi: 10.1016/j.brs.2016.03.010. Epub 2016 Mar 16.

Comentários:
Este artigo, publicado em 2016, é posterior a publicação do Guideline de 2014 que revelou nível A de evidência para o tratamento da depressão a partir da estimulação magnética transcraniana, utilizando-se para isso bobina em figura de 8, entre 30 a 40 sessões diárias de 2ª à 6ª feira, alocada na região dorso lateral do cortex pré frontal à esquerda. Estudo interessante, enfatiza tal utilização sobretudo para pacientes com baixa tolerância à medicação ou mesmo refratários reforçando a eficácia da estimulação magnética transcraniana repetitiva neste grupo de pacientes.

Dr. Paulo de Mello
Médico Neurologista Clínico pela Escola Paulista de Medicina – UNIFESP
Especialista em Medicina Comportamental pela UNIFESP
Psicanalista neo-kleiniano e Mestre em Psicologia da Saúde pela UMESP
Coordenador do GEPECH – Grupo de Estudos e Pesquisa em Comportamento Humano (CEMCO/UNIFESP)