THERAPEUTIC APPROACHES FOR RESISTANT DEPRESSION: AN INTEGRATIVE REVIEW BETWEEN PHARMACOLOGY AND DEEP BRAIN STIMULATION

• DOI: 10.22533/at.ed.1593742318094

• Palavras-chave: treatment-resistant depressive disorder, pharmacological treatment, deep brain stimulation and depression.

• Keywords: treatment-resistant depressive disorder, pharmacological treatment, deep brain stimulation and depression.

• Abstract:

  Resistant depression represents a significant clinical challenge, with many patients not responding adequately to conventional pharmacological treatments. In this context, deep brain stimulation (DBS) emerges as a promising alternative. This integrative review aims to critically compare the efficacy and safety of pharmacology and DBS in treating drug-resistant depression, providing valuable insights to guide clinical practice. We performed a comprehensive search for articles published between 2019 and 2023 in academic databases, including PubMed and Scielo. Clinical studies, systematic reviews and meta-analyses that investigated both treatment modalities were selected, as well as those that directly compared their clinical results. The quality of the included studies was assessed and synthesized. Analysis of selected studies revealed that pharmacology continues to be a widely adopted treatment option, but has limitations related to lack of response in a significant subset of patients and adverse side effects. DBS has demonstrated promising results in patients resistant to pharmacological treatments and conventional therapies, with significant improvement in reducing depressive symptoms in many cases. This integrative review highlights the importance of considering individualized therapeutic approaches for patients with resistant depression. Although pharmacology remains a fundamental basis in treatment, deep brain stimulation demonstrates potential as an effective and safe therapeutic option for patients who do not respond to conventional treatments. The choice between these approaches must be guided by careful assessment of patient characteristics, preferences, risks, and benefits. More research is needed to further clarify the underlying and long-term mechanisms of DBS, as well as identify patients who will benefit most from each treatment modality.