ORCID Profile
0000-0002-6310-3571
Current Organisations
New York University Tandon School of Engineering
,
Universidade de São Paulo
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Publisher: EDITORA SCIENTIFIC
Date: 06-2016
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JAD.2019.12.009
Abstract: Cognitive deficits in major depressive disorder (MDD) are associated with low quality of life and higher suicide risk. Antidepressant drugs have modest to null effects in improving such deficits. Therefore, we investigated the cognitive effects of transcranial direct current stimulation (tDCS), which is a promising antidepressant non-pharmacological intervention, in MDD. An exploratory analysis on cognitive performance was conducted in 243 depressed patients from the Escitalopram vs. Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS), a sham-controlled study comparing the efficacy of tDCS vs. escitalopram. A neuropsychological battery was applied at baseline and endpoint (10 weeks of treatment) to create composite cognitive scores (processing speed, working memory, and verbal fluency). Linear mixed regression models were used to evaluate changes according to intervention groups, adjusted for confounding variables (age, years of schooling, gender, and benzodiazepine use) and depression improvement. No cognitive deterioration was observed in any group. Patients receiving tDCS presented reduced practice gains compared to placebo in processing speed. In patients receiving escitalopram vs. placebo and in the subgroup of clinical responders (>50% depression improvement from baseline), those receiving tDCS vs. placebo presented increased performance in verbal fluency. No significant differences between tDCS and escitalopram groups were detected. Absence of healthy controls. Prefrontal tDCS did not lead to cognitive deficits in depressed patients, although it reduced practice effects in processing speed. tDCS responders presented increased performance in verbal fluency. Further investigation of tDCS cognitive effects in depression is warranted.
Publisher: Oxford University Press (OUP)
Date: 12-07-2022
Abstract: Impaired insight into the illness and its consequences is associated with poor outcomes in schizophrenia. While transcranial direct current stimulation (tDCS) may represent a potentially effective treatment strategy to relieve various symptoms of schizophrenia, its impact on insight remains unclear. To investigate whether tDCS would modulate insight in patients with schizophrenia, we undertook a meta-analysis based on results from previous RCTs that investigated the clinical efficacy of tDCS. We hypothesize that repeated sessions of tDCS will be associated with insight improvement among patients. PubMed and ScienceDirect databases were systematically searched to identify RCTs that delivered at least 10 tDCS sessions in patients with schizophrenia. The primary outcome was the change in insight score, assessed by the Positive and Negative Syndrome Scale (PANSS) item G12 following active tDCS sessions as opposed to sham stimulation. Effect sizes were calculated for all studies and pooled using a random-effects model. Meta-regression and subgroup analyses were conducted. Thirteen studies (587 patients with schizophrenia) were included. A significant pooled effect size (g) of −0.46 (95% CI [−0.78 −0.14]) in favor of active tDCS was observed. Age and G12 score at baseline were identified as significant moderators, while change in total PANSS score was not significant. Ten sessions of active tDCS with either frontotemporoparietal or bifrontal montage may improve insight into the illness in patients with schizophrenia. The effect of this treatment could contribute to the beneficial outcomes observed in patients following stimulation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1097/PSY.0000000000000336
Abstract: Debate has focused on the effects of the selective serotonin reuptake inhibitor (SSRI) antidepressants on heart rate (HR) and HR variability (HRV), both of which are predictors of adverse cardiovascular events. Here, we examine the associations between specific SSRI antidepressants and resting state HR (and HRV) after accounting for a host of potential confounding factors using propensity score techniques. Participants included 10,466 not taking antidepressants, 46 participants taking escitalopram, 86 taking citalopram, 66 taking fluoxetine, 103 taking paroxetine, and 139 taking sertraline. HR and HRV (root mean square of successive squared differences, high frequency) were extracted from 10-minute resting-state ECGs. Analyses including propensity score weighting and matching were conducted using R-statistics to control for potentially confounding variables. Major findings indicated that users of all SSRI medications—except fluoxetine—displayed lower HRV relative to nonusers. Users of paroxetine also displayed significantly lower HRV relative to users of citalopram (Cohen's d = 0.42), fluoxetine (Cohen's d = 0.54), and sertraline (Cohen's d = 0.35), but not escitalopram. Although associations were also observed for HR, these were less robust than those for HRV. Although paroxetine is associated with decreases in HRV relative to nonusers, as well as users of other SSRI medications, fluoxetine was the only medication not to display significant alterations in HR or HRV. These conclusions are limited by the cross-sectional design and nonrandomized nature of medication prescriptions. Findings highlight the importance of focusing on specific medications, rather than more heterogeneous groupings according to antidepressant action, and may have implications for health and well-being for the longer term.
Publisher: Springer US
Date: 2022
Publisher: Wiley
Date: 29-03-2016
DOI: 10.1111/ACPS.12565
Abstract: Major depressive disorder (MDD) is a clinically heterogeneous condition. However, the role of cortical glutamate and gamma-aminobutyric acid (GABA) receptor-mediated activity, implicated in MDD pathophysiology, has not been explored in different MDD subtypes. Our aim was to assess the atypical and melancholic depression subtypes regarding potential differences in GABA and glutamate receptor-mediated activity through established transcranial magnetic stimulation (TMS) neurophysiological measures from the motor cortex. We evaluated 81 subjects free of antidepressant medication, including 21 healthy controls and 20 patients with atypical, 20 with melancholic, and 20 with undifferentiated MDD. Single and paired-pulse TMS paradigms were used to evaluate intracortical facilitation (ICF), cortical silent period (CSP), and short intracortical inhibition (SICI), which index glutamate, GABAB receptor-, and GABAA receptor-mediated activity respectively. Patients with MDD demonstrated significantly decreased mean CSP values than healthy controls (Cohen's d = 0.22-0.3, P < 0.01 for all comparisons). Atypical depression presented a distinct cortical excitability pattern of decreased cortical inhibition and increased cortical facilitation, that is, an increased mean ICF and SICI ratios than other depression subtypes (d = 0.22-0.33, P < 0.01 for all comparisons). Different MDD subtypes may demonstrate different neurophysiology in relation to GABAA and glutamatergic activity. TMS as an investigational tool might be useful to distinguish between different MDD subtypes.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.NEULET.2015.03.042
Abstract: The dorsolateral prefrontal cortex (DLPFC) is involved in the cognitive appraisal and modulation of the pain experience. In this sham-controlled study, with healthy volunteers, we used bi-hemispheric transcranial direct current stimulation (tDCS) over the DLPFC to assess emotional reactions elicited by pain observation. Left-cathodal/right-anodal tDCS decreased valence and arousal evaluations compared to other tDCS conditions. Compared to sham condition, both left-cathodal/right-anodal and left-anodal/right-cathodal tDCS decreased hostility, sadness and self-pain perception. These decreased sensations after both active tDCS suggest a common role for left and right DLPFC in personal distress modulation. However, the differences in arousal and valence evaluations point to distinct roles of lateralized DLPFC in cognitive empathy, probably through distinct emotion regulation mechanisms.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: Springer Science and Business Media LLC
Date: 15-12-2013
DOI: 10.1007/S00213-013-3374-4
Abstract: Black box warnings for young adults under the age of 25 years indicate that antidepressants may increase risk of suicide. While underlying mechanisms for age-related treatment effects remain unclear, vagally mediated cardiovascular function may play a key role. Decreased heart rate (HR) and an increase in its variability (HRV) improve one's capacity to adapt to environmental stress and attenuate risk for suicide. Using a double blind, randomized, placebo-controlled, crossover, experimental study, we examine whether a single dose of escitalopram (20 mg) attenuates cardiovascular responses to stress under experimental conditions and determine whether age moderates these effects. Forty-four healthy females received a single dose of escitalopram (20 mg) and placebo treatment separated by a 1-week interval (>5 half-lives). HR and high frequency HRV (HF HRV normalized units 0.15-0.40 Hz) were measured during resting state and stress. While escitalopram attenuated the increase in HR and increased HF HRV, these moderate to large effects were only significant in participants over 25 years of age. No beneficial cardiovascular effects of escitalopram were observed in those under the age of 25. Maturational differences in the development of the prefrontal cortex--a critical region in the central network of autonomic control--may underpin these differential findings. This study provides a theoretical framework on which future research on treatment-emergent suicidality in clinical populations could be based.
Publisher: IOP Publishing
Date: 03-09-2015
DOI: 10.1088/0967-3334/36/10/2119
Abstract: Linear and nonlinear analyses of heart rate variability (HRV) have been largely used to evaluate the autonomic balance directed to the cardiovascular system. However, comparative studies evaluating the agreement between methods are scarce. Therefore, our aim was to examine the relationship between spectral (SPA linear) and symbolic analyses (SYA nonlinear) indexes. A subs le of 683 participants of the Brazilian Longitudinal Study of Adult Health was investigated. Linear and nonlinear analyses were obtained from 10 min ECG recording at rest. Reliability and agreement between methods were evaluated by kappa-statistic and proportion of agreement. According to SYA, the most frequent pattern was P1V (sympathovagal balance, without sympathetic or vagal predominance) comprising 62.7% of the s le, followed by P2V (vagal predominance) with 33.2%, and finally P0V pattern (sympathetic predominance) with 4.1%. Overall proportion of agreement between SYA and SPA was 39.68% (95% CI 0.360-0.433), with expected agreement by chance of 30.8%. Kappa value was 0.128 indicating a slight agreement between methods. Proportion of agreement was 7.93% (95% CI 0.032-0.126) for predominant sympathetic modulation, 10.39% (95% CI 0.075-0.132) for sympathovagal modulation, and 40.29% (95% CI 0.361-0.444) for parasympathetic modulation. Our data provide evidence for important differences between SPA and SYA on HRV analysis. More studies are needed to clarify the causes of disagreement between two methods designed to evaluate the autonomic modulation of heart beats.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PSC.2018.05.002
Abstract: Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been gaining favor as a viable tool in Psychiatry. The purpose of this review is to summarize the evidence of tDCS as a treatment of disorders such as depression, schizophrenia, and obsessive-compulsive disorder (OCD). Current findings indicate that tDCS is probably effective in non-treatment-resistant depressive patients. Regarding schizophrenia and OCD, present evidence is not robust enough, although preliminary results indicate that tDCS is a promising technique. Therefore, more trials are needed before using tDCS in a clinical setting.
Publisher: Royal College of Psychiatrists
Date: 06-2016
DOI: 10.1192/BJP.BP.115.164715
Abstract: Transcranial direct current stimulation (tDCS) is a non-pharmacological intervention for depression. It has mixed results, possibly caused by study heterogeneity. To assess tDCS efficacy and to explore in idual response predictors. Systematic review and in idual patient data meta-analysis. Data were gathered from six randomised sham-controlled trials, enrolling 289 patients. Active tDCS was significantly superior to sham for response (34% v. 19% respectively, odds ratio (OR) = 2.44, 95% CI 1.38–4.32, number needed to treat (NNT) = 7), remission (23.1% v. 12.7% respectively, OR = 2.38, 95% CI 1.22–4.64, NNT = 9) and depression improvement ( B coefficient 0.35, 95% CI 0.12–0.57). Mixed-effects models showed that, after adjustment for other predictors and confounders, treatment-resistant depression and higher tDCS ‘doses' were, respectively, negatively and positively associated with tDCS efficacy. The effect size of tDCS treatment was comparable with those reported for repetitive transcranial magnetic stimulation and antidepressant drug treatment in primary care. The most important parameters for optimisation in future trials are depression refractoriness and tDCS dose.
Publisher: Wiley
Date: 22-02-2017
DOI: 10.1002/JEAB.247
Abstract: Robotics is emerging as a promising tool for aiding research on animal behavior. The possibility of generating customizable, controllable, and standardized robotic stimuli has been demonstrated through a number of behavioral assays, involving vertebrates and invertebrates. However, the specific appraisal of the nature of robotic stimuli is currently lacking. Here, we attempt to evaluate this aspect in zebrafish, through a within-subject design in which experimental subjects are faced with three experimental conditions. In the first test, we investigated sociability by measuring zebrafish response to a conspecific separated by a one-way glass. In the second test, we studied zebrafish behavior in response to a 3D-printed zebrafish replica actuated along realistic trajectories through a novel four-degree-of-freedom robotic platform. Last, we investigated fear responses in a shelter-seeking test. In agreement with our expectations, zebrafish exhibited an equivalent preference for live and robotic stimuli, and the degree of preference for the robotic replica correlated negatively with the in idual propensity to seek shelter. The equivalent preference for the replica and conspecific suggests that the appraisal of the target stimuli is analogous. The preliminary evidence of a correlation between behavioral responses across tests points to the readability of robotics-based approaches to investigate interin idual differences.
Publisher: Wiley
Date: 02-01-2018
DOI: 10.1111/PSYP.13052
Abstract: Heart rate variability (HRV) is a psychophysiological phenomenon with broad implications, providing an accessible index of vagal function, underpinning psychological constructs, including the capacity for social engagement and emotion regulation, and may predict future morbidity and mortality. However, the lack of reference values for short-term HRV indices for participants of both sexes across the age spectrum is a limiting factor. This was the objective of the present study. Resting electrocardiographic records were obtained from 13,214 participants (both sexes, 35-74 years), and HRV indices in time and frequency domains (mean ± SD) were determined from 5-min records. Results were based on a subs le of 2,874 nonmedicated, healthy participants stratified by sex across 10-year age groupings. Men showed lower heart rate (HR, 64 ± 8 bpm vs. 68 ± 8 bpm, p < .05) and normalized high frequency (HF 39.4 ± 18.0 normalized units [n.u.] vs. 50.4 ± 18.5 n.u., p < .05) than women, and higher N-N variance (2,214 ± 1,890 ms
Publisher: Elsevier BV
Date: 07-2012
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.PSYCHRES.2017.09.028
Abstract: Major depressive disorder (MDD) is associated with decreased heart rate variability (HRV), a predictor of cardiovascular morbidity by many, but not all studies. This inconsistency could be due to the association of HRV with specific depressive symptoms. Here, we investigated the association of HRV parameters with components of depressive symptoms from 120 MDD patients, at baseline of a published trial comparing the effect of sertraline to transcranial direct current stimulation. We used Principal Component Analysis to extract components of the Hamilton Rating Scale for Depression (HAM-D-17), the Montgomery Asberg Depression Rating Scale (MADRS) and the Beck Inventory for Depressive Symptomatology (BDI). We constructed one equation of multiple linear regression for each HRV parameter as the dependent variable, and the components of depressive symptoms of the three scales as the independent ones, adjusted for age and gender. A component of HAM-D-17 predicted LF/HF (low frequency/high frequency) and a component of MADRS predicted LF (low frequency). "Guilt" and "loss of interest leasure in activities" were present in the components of both scales, and the MADRS component also included "psychomotor retardation". These results suggest that melancholic features might be relevant for the association between MDD and HRV. Considering multiple comparisons, these results are preliminary.
Publisher: Oxford University Press (OUP)
Date: 10-2013
DOI: 10.1017/S1461145713000497
Abstract: Decreased heart rate variability (HRV) is a cardiovascular predictor of mortality. Recent debate has focused on whether reductions in HRV in major depressive disorder (MDD) are a consequence of the disorder or a consequence of pharmacotherapy. Here we report on the impact of transcranial direct current stimulation (tDCS), a non-pharmacological intervention, vs. sertraline to further investigate this issue. The employed design was a double-blind, randomized, factorial, placebo-controlled trial. One hundred and eighteen moderate-to-severe, medication-free, low-cardiovascular risk depressed patients were recruited for this study and allocated to either active/sham tDCS (10 consecutive sessions plus two extra sessions every other week) or placebo/sertraline (50 mg/d) for 6 wk. Patients were age and gender-matched to healthy controls from a concurrent cohort study [the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)]. The impact of disorder, treatment and clinical response on HRV (root mean square of successive differences and high frequency) was examined. Our findings confirmed that patients displayed decreased HRV relative to controls. Furthermore, HRV scores did not change following treatment with either a non-pharmacological (tDCS) or pharmacological (sertraline) intervention, nor did HRV increase with clinical response to treatment. Based on these findings, we discuss whether reduced HRV is a trait-marker for MDD, which may predispose patients to a host of conditions and disease even after response to treatment. Our findings have important implications for our understanding of depression pathophysiology and the relationship between MDD, cardiovascular disorders and mortality.
Publisher: Massachusetts Medical Society
Date: 29-06-2017
Publisher: Springer Science and Business Media LLC
Date: 10-2021
DOI: 10.1038/S41591-021-01498-0
Abstract: Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Oxford University Press (OUP)
Date: 23-09-2013
Publisher: FapUNIFESP (SciELO)
Date: 04-2014
Publisher: Elsevier BV
Date: 02-2022
Publisher: Frontiers Media SA
Date: 22-01-2015
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.BRS.2016.11.005
Abstract: Treatment-emergent mania/hypomania (TEM) is a possible adverse effect of pharmacological and non-pharmacological antidepressant treatments. We performed a systematic review and meta-analysis to evaluate the risk of TEM in depressed patients during randomized, sham-controlled trials (RCTs). Medline database, from the first date available to August 12, 2016. From 283 references, 10 RCTs were identified. Only 3 of them described TEM. In active and sham groups, respectively, only 8 of 226 (3.5%) and 1 of 190 (0.5%) participants presented TEM. This difference was not statistically significant (OR = 1.79, 95% CI = 0.6 to 5.32). There were also five additional reports of TEM in participants not on RCTs. No risk factors for TEM were identified. Low number of studies and TEM reports. Despite previous reports, active vs. sham tDCS was not associated with a significantly greater number of TEM episodes.
Publisher: American Medical Association (AMA)
Date: 02-2018
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.NEUBIOREV.2018.04.008
Abstract: Transcranial direct current stimulation (tDCS) has emerged as a promising new treatment for major depression. While recent randomised, sham-controlled studies found tDCS to have antidepressant effects, it remains to be determined whether a tDCS treatment course may also enhance cognitive function independent of mood effects in depressed patients. This systematic review and in idual patient data (IPD) meta-analysis examined cognitive outcomes from randomised, sham-controlled trials of tDCS treatment for major depression. Seven randomised, sham-controlled trials (n = 478 participants, 260 in active and 218 in sham) of tDCS for major depression were included. Results showed no cognitive enhancement after active tDCS compared to sham for the 12 cognitive outcomes investigated. Active relative to sham tDCS treatment was associated with reduced performance gains on a measure of processing speed (β = -0.33, 95% CI -0.58 -0.08, p = 0.011). Active tDCS treatment for depression did not show cognitive benefits independent of mood effects. Rather, tDCS treatment relative to sham stimulation for major depression may instead be associated with a reduced practice effect for processing speed.
Publisher: Hindawi Limited
Date: 26-02-2020
DOI: 10.1002/DA.23004
Publisher: Springer Science and Business Media LLC
Date: 03-06-2021
DOI: 10.1038/S41562-021-01108-6
Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for ex le, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.
Publisher: Escola Bahiana de Medicina e Saude Publica
Date: 13-09-2023
Publisher: American Psychological Association (APA)
Date: 2014
Publisher: Hindawi Limited
Date: 14-01-2019
DOI: 10.1002/DA.22878
Abstract: The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. Twenty-four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan-Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse. Out of 24 patients, 18 completed the follow-up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow-up was 73.5% (95% confidence interval, 50-87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment- vs. antidepressant treatment-resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed. An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6-month follow up of tDCS responders, particularly for nontreatment-resistant patients.
Publisher: FapUNIFESP (SciELO)
Date: 06-2015
DOI: 10.1590/1516-3180.2014.00351712
Abstract: CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS).DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil.METHODS: ELECT-TDCS compares the efficacy of active tDCS lacebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS lacebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging.RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS.CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.PNPBP.2019.109836
Abstract: We evaluated the efficacy and acceptability of transcranial direct current stimulation (tDCS) for treating acute depressive episodes using in idual patient data that provide more precise estimates than aggregate data meta-analysis. A systematic review of placebo-controlled trials on tDCS as only intervention was conducted until December-2018. Data from each study was collated to estimate odds ratio (OR) and number needed to treat (NNT) of response and remission, and depression improvement. Endpoints were pre-determined. Nine eligible studies (572 participants), presenting moderate/high certainty of evidence, were included. Active tDCS was significantly superior to sham for response (30.9% vs. 18.9% respectively OR = 1.96, 95%CI [1.30-2.95], NNT = 9), remission (19.9% vs. 11.7%, OR = 1.94 [1.19-3.16], NNT = 13) and depression improvement (effect size of β = 0.31, [0.15-0.47]). Moreover, continuous clinical improvement was observed even after the end of acute tDCS treatment. There were no differences in all-cause discontinuation rates and no predictors of response were identified. To conclude, active tDCS was statistically superior to sham in all outcomes, although its clinical effects were moderate.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.EURONEURO.2013.03.009
Abstract: Transcranial direct current stimulation (tDCS) has been intensively investigated as a non-pharmacological treatment for major depressive disorder (MDD). While many studies have examined the genetic predictors of antidepressant medications, this issue remains to be investigated for tDCS. In the current study, we evaluated whether the BDNF Val66Met and the 5-HTT (5-HTTLPR) polymorphisms were associated with tDCS antidepressant response. We used data from a factorial trial that evaluated the efficacy of tDCS and sertraline and enrolled 120 moderate-to-severe, antidepressant-free participants. In the present study, we used analyses of variance to evaluate whether the BDNF (Val/Val vs. Met-carries) and 5-HTTLPR alleles (long/long vs short-carriers) were predictors of tDCS (active/sham) and sertraline (sertraline lacebo) response. Analyses were conducted on the polymorphisms separately and also on their interaction. Genotype frequencies were in Hardy-Weinberg equilibrium. BDNF polymorphism was not associated with treatment response. We found that 5-HTTLPR predicted tDCS effects as long/long homozygotes displayed a larger improvement comparing active vs. sham tDCS, while short-allele carriers did not. A dose-response relationship between active-sham differences with the long allele was also suggested. These results strengthen the role of the serotonergic system in the tDCS antidepressant effects and expand previous findings that reported that tDCS mechanisms of action partially involve serotonergic receptors. Therefore, we hypothesize that tDCS is a neuromodulation technique that acts over depression through the modulation of serotonergic system and that tDCS "top-down" antidepressant effects might not be optimal in brain networks with a hyperactive amygdala inducing bottom-up effects, such as occurs in short-carriers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
DOI: 10.1097/PR9.0000000000000692
Abstract: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine (3) level A recommendation against the use of anodal M1 tDCS for low back pain and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1111/NER.12527
Publisher: Frontiers Media SA
Date: 25-02-2015
Publisher: Elsevier BV
Date: 07-2021
DOI: 10.1016/J.PNPBP.2021.110261
Abstract: Randomised clinical trials (RCTs) investigating transcranial direct current stimulation (tDCS) efficacy for depression show significant heterogeneity in outcomes. To investigate the magnitude of the sham tDCS response and its potential moderators in the treatment of depression. A systematic review and aggregate meta-analysis (PROSPERO ID CRD42020161254). The systematic review was conducted in the PubMed, Scopus (EMBASE) and Cochrane Library databases. Only RCTs enrolling adult subjects with an acute depressive episode with a sham tDCS group were included. Twenty-three studies (twenty-five datasets, 501 participants) were included. Sham tDCS response was large (Hedges' g = 1.09 95% CI: 0.8 .38). Secondary and subgroup analyses showed that sham protocols employing a r -up/r -down at the beginning and end of stimulation presented a significantly lower sham response compared to other protocols. Univariate meta-regression analyses found that sham response was associated with higher risk of blinding bias, and with thetreatment effect size of the active tDCS group. Subgroup analyses also showed that placement of the cathode over the lateral right frontal area (F8) presented a significantly lower sham response. Other moderators, including treatment resistance, baseline severity of depressive symptoms, and total charge delivered were not associated with the magnitude of the sham response. The sham tDCS response was large. Our findings demonstrate the need for standardization of sham tDCS protocols and bring attention to important considerations that can guide future RCTs employing tDCS for the treatment of MDD.
Publisher: Frontiers Media SA
Date: 2013
Publisher: American Psychiatric Association Publishing
Date: 12-2014
DOI: 10.1176/APPI.AJP.2014.13121605
Abstract: Increases in resting-state heart rate and decreases in its variability are associated with substantial morbidity and mortality, yet contradictory findings have been reported for the effects of the mood and anxiety disorders and of antidepressants. The authors investigated heart rate and heart rate variability in a large cohort from Brazil, using propensity score weighting, a relatively novel method, to control for numerous potential confounders. A total of 15,105 participants were recruited in the Brazilian Longitudinal Study of Adult Health. Mood and anxiety disorders were ascertained using the Portuguese version of the Clinical Interview Schedule-Revised. Heart rate and its variability were extracted from 10-minute resting-state electrocardiograms. Regressions weighted by propensity scores were carried out to compare participants with and without depressive or anxiety disorders, as well as users and non-users of antidepressants, on heart rate and heart rate variability. Use of antidepressants was associated with increases in heart rate and decreases in its variability. Effects were most pronounced for the tricyclic antidepressants (Cohen's d, 0.72-0.81), followed by serotonin and norepinephrine reuptake inhibitors (Cohen's d, 0.42-0.95) and other antidepressants (Cohen's d, 0.37-0.40), relative to participants not on antidepressants. Only participants with generalized anxiety disorder showed robust, though small, increases in heart rate and decreases in its variability after propensity score weighting. The findings may, in part, underpin epidemiological findings of increased risk for cardiovascular morbidity and mortality. Many factors that have an adverse impact on cardiac activity were controlled for in this study, highlighting the importance of cardiovascular risk reduction strategies. Further study is needed to examine whether, how, and when such effects contribute to morbidity and mortality.
Publisher: The Royal Society
Date: 09-2019
Abstract: Invasive alien species threaten bio ersity worldwide and contribute to biotic homogenization, especially in freshwaters, where the ability of native animals to disperse is limited. Robotics may offer a promising tool to address this compelling problem, but whether and how invasive species can be negatively affected by robotic stimuli is an open question. Here, we explore the possibility of modulating behavioural and life-history responses of mosquitofish by varying the degree of biomimicry of a robotic predator, whose appearance and locomotion are inspired by natural mosquitofish predators. Our results support the prediction that real-time interactions at varying swimming speeds evoke a more robust antipredator response in mosquitofish than simpler movement patterns by the robot, especially in in iduals with better body conditions that are less prone to take risks. Through an information-theoretic analysis of animal–robot interactions, we offer evidence in favour of a causal link between the motion of the robotic predator and a fish antipredator response. Remarkably, we observe that even a brief exposure to the robotic predator of 15 min per week is sufficient to erode energy reserves and compromise the body condition of mosquitofish, opening the door for future endeavours to control mosquitofish in the wild.
Publisher: Elsevier
Date: 2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.PNPBP.2017.10.016
Abstract: Although several studies indicate that placebo response is large to antidepressant pharmacotherapy in major depressive disorder (MDD), no updated meta-analysis has quantified the magnitude of the placebo (sham) response to repetitive transcranial magnetic stimulation (rTMS) in MDD yet. To conduct a systematic review and meta-analysis on this issue in randomized controlled trials (RCTs) involving participants with MDD and to explore potential moderators. PubMed/MEDLINE, Embase, PsycINFO, and Web of Science electronic databases were searched from inception up to March 15, 2017 for RCTs that investigated the efficacy of any rTMS modality compared to sham intervention in participants with acute depressive episodes. Cochrane Risk of Bias Tool was used to estimate risks. We estimated the placebo effect size (Hedges's g, random-effects model) response using placebo groups baseline and endpoint depressive symptom scores. Meta-regressions have been employed to explore potential moderators of response. Sixty-one studies met eligibility criteria (N=1328 mean age, 47years 57% females). Placebo response was large (g=0.8, 95% CI=0.65-0.95, p<0.01) regardless of the modality of intervention. Placebo response was directly associated with publication year and depression improvement of the active group, and inversely associated with higher levels of treatment-resistant depression. Other moderators, including gender, age, and stimulator type, were not associated with the outcome. Overall, 24.6%, 67.2%, and 8.2% of studies had an overall low, unclear, and high bias risk, respectively. Placebo response in rTMS depression trials was large and associated with depression improvement of the active treatment group. Such result suggests that excluding placebo responders with a run-in phase may not confer advantage since response to 'active' rTMS may decrease as well. Moreover, placebo response may be a component of therapeutic response to rTMS in MDD. In addition, placebo response increase over time could indicate improvement in rTMS trial designs, including better sham rTMS methods.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 2022
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JAD.2017.06.021
Abstract: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation modality that has been increasingly used for major depressive disorder (MDD) treatment. Although studies in healthy volunteers showed that the technique is well-tolerated, tDCS safety and acceptability have not been sufficiently explored in patients with MDD. We collected in idual patient data from 6 randomized clinical trials that had been previously identified in a systematic review and meta-analysis. Primary outcomes were safety (rate of adverse events) and acceptability (rate of dropouts). Secondary outcomes were clinical, demographic and treatment predictors of the primary outcomes. Dropout rates between active (8.8%) and sham (12%) groups were not significantly different (OR= 0.7, p=0.38). Adverse event rates between active (73.5%) and sham (68.3%) groups were not significantly different (OR= 1.4, p= 0.23). Higher current densities were associated with lower adverse event rates. Dropout reasons were not systematically reported and adverse events were not collected using questionnaires standardized across studies. Active tDCS is as acceptable and safe as sham tDCS, as found in randomized clinical trials of MDD.
Publisher: Elsevier BV
Date: 02-2201
Publisher: American Society of Civil Engineers (ASCE)
Date: 09-2021
Publisher: American Medical Association (AMA)
Date: 02-2017
DOI: 10.1001/JAMAPSYCHIATRY.2016.3644
Abstract: Although several strategies of repetitive transcranial magnetic stimulation (rTMS) have been investigated as treatment of major depressive disorder (MDD), their comparative efficacy and acceptability is unknown. To establish the relative efficacy and acceptability of the different modalities of rTMS used for MDD by performing a network meta-analysis, obtaining a clinically meaningful treatment hierarchy. PubMed/MEDLINE, EMBASE, PsycInfo, and Web of Science were searched up until October 1, 2016. Randomized clinical trials that compared any rTMS intervention with sham or another rTMS intervention. Trials performing less than 10 sessions were excluded. Two independent reviewers used standard forms for data extraction and quality assessment. Random-effects, standard pairwise, and network meta-analyses were performed to synthesize data. Response rates and acceptability (dropout rate). Remission was the secondary outcome. Effect sizes were reported as odds ratios (ORs) with 95% CIs. Eighty-one studies (4233 patients, 59.1% women, mean age of 46 years) were included. The interventions more effective than sham were priming low-frequency (OR, 4.66 95% CI, 1.70-12.77), bilateral (OR, 3.96 95% CI, 2.37-6.60), high-frequency (OR, 3.07 95% CI, 2.24-4.21), θ-burst stimulation (OR, 2.54 95% CI, 1.07-6.05), and low-frequency (OR, 2.37 95% CI, 1.52-3.68) rTMS. Novel rTMS interventions (accelerated, synchronized, and deep rTMS) were not more effective than sham. Except for θ-burst stimulation vs sham, similar results were obtained for remission. All interventions were at least as acceptable as sham. The estimated relative ranking of treatments suggested that priming low-frequency and bilateral rTMS might be the most efficacious and acceptable interventions among all rTMS strategies. However, results were imprecise and relatively few trials were available for interventions other than low-frequency, high-frequency, and bilateral rTMS. Few differences were found in clinical efficacy and acceptability between the different rTMS modalities, favoring to some extent bilateral rTMS and priming low-frequency rTMS. These findings warrant the design of larger RCTs investigating the potential of these approaches in the short-term treatment of MDD. Current evidence cannot support novel rTMS interventions as a treatment for MDD. clinicaltrials.gov Identifier: PROSPERO CRD42015019855.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2021
DOI: 10.1186/S12916-020-01876-4
Abstract: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. We performed an ecological study using VR data ranging from 2000 to 2017, dependent on in idual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Our subnational estimates of HIV mortality revealed significant spatial variation and erging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1111/NER.12080
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.ATHEROSCLEROSIS.2015.04.800
Abstract: Studies focusing on the association between anxiety/depressive symptoms and accelerated subclinical atherosclerosis have yielded mixed results. Our aim is to examine associations between anxiety/depressive symptoms, common mental disorder (CMD), major depression disorder (MDD) or generalized anxiety disorder (GAD) and carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline. The ELSA-Brasil baseline assessment included CIMT measurements and the Clinical Interview Schedule - Revised (CIS-R), a validated questionnaire for anxiety/depressive symptoms/diagnoses. We analyzed participants without previous coronary heart disease or stroke, and with high-quality CIMT images. We built regression models to determine whether the CIS-R score, CMD, MDD or GAD were associated with maximal CIMT levels. The study s le comprised 9744 participants. We found that in iduals with higher CIS-R scores (Odds ratio for one standard deviation increase [OR]:1.12 95% confidence interval [95%CI]:1.06-1.19), CMD (OR:1.22 95%CI:1.07-1.38) and GAD (OR:1.19 95%CI:1.01-1.41) had significantly higher odds of being classified in the highest age, sex and race-specific CIMT quartile. In the linear models, after adjustment for traditional cardiovascular risk factors, higher CIS-R scores (β:0.005 P = 0.010) and GAD (β:0.010 P = 0.049) were independently associated with CIMT values. In iduals with more symptoms of anxiety and/or depression, or diagnoses of CMD or GAD, had higher CIMT values, compared to peers of same age, sex and race. CIS-R scores and GAD were independently associated with higher CIMT values. These results suggest an association between anxiety/depressive symptoms (and, most notably, GAD) and accelerated subclinical atherosclerosis.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2021
DOI: 10.1038/S41586-021-03658-1
Abstract: Since its discovery
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1111/NER.12167
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.CHEST.2017.10.044
Abstract: Nasal CPAP is the "gold standard" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA. The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" and "CPAP" or "sleep apnea" and "oronasal mask" or "OSA" and "oronasal CPAP" or "oronasal mask" and "adherence." Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article (2) randomized or nonrandomized trials and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence. We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59 95% CI, -0.82 to -0.37 P < .001) (on average, +1.5 cm H Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks. PROSPERO database No.: CRD42017064584 URL: www.crd.york.ac.uk rospero/.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2021
DOI: 10.1007/S00406-020-01121-2
Abstract: Bipolar depression is associated with marked cognitive deficits. Pharmacological treatments for this condition are limited and may aggravate depressive and cognitive symptoms. Therefore, therapeutic interventions that preserve adequate cognitive functioning are necessary. Our previous results demonstrated significant clinical efficacy of transcranial direct current stimulation (tDCS) in the Bipolar Depression Electrical Treatment Trial (BETTER). Here, cognitive outcomes of this study are reported. We randomized 59 patients with bipolar disorder I or II in an acute depressive episode to receive active (12 2 mA, 30-min, anodal-left, cathodal-right prefrontal cortex tDCS sessions) or sham tDCS. Patients were on stable pharmacological regimen for at least 2 weeks. A battery of 12 neuropsychological assessments in five cognitive domains (attention and processing speed, memory, language, inhibitory control, and working memory and executive function) was performed at baseline, after two weeks and at endpoint (week 6). No significant differences between groups over 6 weeks of treatment were observed for any cognitive outcomes. Moreover, no decrease in cognitive performance was observed. Our findings warrant further replication in larger studies. Trial Registration: clinicaltrials.gov Identifier: NCT02152878.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.NEULET.2015.02.036
Abstract: Dorsolateral prefrontal cortex (DLPFC) hypoactivity and subcortical hyperactivity have been associated to cognitive impairment for non-emotional ("cold") and emotional ("hot") working memory tasks in major depressive disorder (MDD). We investigated whether an increase of DLPFC activity using transcranial direct current stimulation (tDCS) would differently influence the performance in working memory tasks in depressed and healthy subjects. Forty young adult participants (20 with MDD and 20 healthy controls) were randomized to a single, sham-controlled, bifrontal (left anodal/right cathodal), 2mA, 30min tDCS session in a parallel design. The n-back and the internal shift task (IST) were used as proxies of cold and hot working memory performance, respectively. Active tDCS compared to sham promoted more accurate and faster responses to the n-back task for both patients and controls. Conversely, only patients presented an improvement in response times for the IST task. Our findings suggest that the mechanisms of tDCS in MDD involve modulation of both cold and hot working memory. We discuss these findings considering the modulatory top-down effects of tDCS on subcortical structures via prefrontal activation, and how spreading of activation might be different for healthy volunteers versus depressed patients. We also discuss the role of tDCS in cognitive amelioration for depressed patients. Finally, the distinct effects of tDCS in the "hot" cognition task for healthy and depressed participants are indicative that tDCS outcomes are also regulated by differences in baseline activity of the stimulated network.
Publisher: Elsevier BV
Date: 07-2022
Location: United States of America
Location: United States of America
No related grants have been discovered for Andre Russowsky Brunoni.