RODRIGO MACHADO VIEIRA
Projetos de Pesquisa
Unidades Organizacionais
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
2 resultados
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- Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression A Randomized Clinical Trial(2018) SAMPAIO-JUNIOR, Bernardo; TORTELLA, Gabriel; BORRIONE, Lucas; MOFFA, Adriano H.; MACHADO-VIEIRA, Rodrigo; CRETAZ, Eric; SILVA, Adriano Fernandes da; FRAGUAS, Renerio; APARICIO, Luana V.; KLEIN, Izio; LAFER, Beny; GOERIGK, Stephan; BENSENOR, Isabela Martins; LOTUFO, Paulo Andrade; GATTAZ, Wagner F.; BRUNONI, Andre RussowskyIMPORTANCE More effective, tolerable interventions for bipolar depression treatment are needed. Transcranial direct current stimulation (tDCS) is a novel therapeutic modality with few severe adverse events that showed promising results for unipolar depression. OBJECTIVE To determine the efficacy and safety of tDCS as an add-on treatment for bipolar depression. DESIGN, SETTING, AND PARTICIPANTS A randomized, sham-controlled, double-blind trial (the Bipolar Depression Electrical Treatment Trial [BETTER]) was conducted from July 1, 2014, to March 30, 2016, at an outpatient, single-center academic setting. Participants included 59 adults with type I or II bipolar disorder in a major depressive episode and receiving a stable pharmacologic regimen with 17-item Hamilton Depression Rating Scale (HDRS-17) scores higher than 17. Data were analyzed in the intention-to-treat sample. INTERVENTIONS Ten daily 30-minute, 2-mA, anodal-left and cathodal-right prefrontal sessions of active or sham tDCS on weekdays and then 1 session every fortnight until week 6. MAIN OUTCOMES AND MEASURES Change in HDRS-17 scores at week 6. RESULTS Fifty-nine patients (40 [68%] women), with a mean (SD) age of 45.9 (12) years participated; 36 (61%) with bipolar I and 23 (39%) with bipolar II disorder were randomized and 52 finished the trial. In the intention-to-treat analysis, patients in the active tDCS condition showed significantly superior improvement compared with those receiving sham (beta(int) = -1.68; number needed to treat, 5.8; 95% CI, 3.3-25.8; P = .01). Cumulative response rates were higher in the active vs sham groups (67.6% vs 30.4%; number needed to treat, 2.69; 95% CI, 1.84-4.99; P = .01), but not remission rates (37.4% vs 19.1%; number needed to treat, 5.46; 95% CI, 3.38-14.2; P = .18). Adverse events, including treatment-emergent affective switches, were similar between groups, except for localized skin redness that was higher in the active group (54% vs 19%; P = .01). CONCLUSIONS AND RELEVANCE In this trial, tDCS was an effective, safe, and tolerable add-on intervention for this small bipolar depression sample. Further trials should examine tDCS efficacy in a larger sample.
- Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group(2018) HIBAR, D. P.; WESTLYE, L. T.; DOAN, N. T.; JAHANSHAD, N.; CHEUNG, J. W.; CHING, C. R. K.; VERSACE, A.; BILDERBECK, A. C.; UHLMANN, A.; MWANGI, B.; KRAEMER, B.; OVERS, B.; HARTBERG, C. B.; ABE, C.; DIMA, D.; GROTEGERD, D.; SPROOTEN, E.; BOEN, E.; JIMENEZ, E.; HOWELLS, F. M.; DELVECCHIO, G.; TEMMINGH, H.; STARKE, J.; ALMEIDA, J. R. C.; GOIKOLEA, J. M.; HOUENOU, J.; BEARD, L. M.; RAUER, L.; ABRAMOVIC, L.; BONNIN, M.; PONTEDURO, M. F.; KEIL, M.; RIVE, M. M.; YAO, N.; YALIN, N.; NAJT, P.; ROSA, P. G.; REDLICH, R.; TROST, S.; HAGENAARS, S.; FEARS, S. C.; ALONSO-LANA, S.; ERP, T. G. M. van; NICKSON, T.; CHAIM-AVANCINI, T. M.; MEIER, T. B.; ELVSASHAGEN, T.; HAUKVIK, U. K.; LEE, W. H.; SCHENE, A. H.; LLOYD, A. J.; YOUNG, A. H.; NUGENT, A.; DALE, A. M.; PFENNIG, A.; MCINTOSH, A. M.; LAFER, B.; BAUNE, B. T.; EKMAN, C. J.; ZARATE, C. A.; BEARDEN, C. E.; HENRY, C.; SIMHANDL, C.; MCDONALD, C.; BOURNE, C.; STEIN, D. J.; WOLF, D. H.; CANNON, D. M.; GLAHN, D. C.; VELTMAN, D. J.; POMAROL-CLOTET, E.; VIETA, E.; CANALES-RODRIGUEZ, E. J.; NERY, F. G.; DURAN, F. L. S.; BUSATTO, G. F.; ROBERTS, G.; PEARLSON, G. D.; GOODWIN, G. M.; KUGEL, H.; WHALLEY, H. C.; RUHE, H. G.; SOARES, J. C.; FULLERTON, J. M.; RYBAKOWSKI, J. K.; SAVITZ, J.; CHAIM, K. T.; FATJO-VILAS, M.; SOEIRO-DE-SOUZA, M. G.; BOKS, M. P.; ZANETTI, M. V.; OTADUY, M. C. G.; SCHAUFELBERGER, M. S.; ALDA, M.; INGVAR, M.; PHILLIPS, M. L.; KEMPTON, M. J.; BAUER, M.; LANDEN, M.; LAWRENCE, N. S.; HAREN, N. E. M. van; HORN, N. R.; FREIMER, N. B.; GRUBER, O.; SCHOFIELD, P. R.; MITCHELL, P. B.; KAHN, R. S.; LENROOT, R.; MACHADO-VIEIRA, R.; OPHOFF, R. A.; SARRO, S.; FRANGOU, S.; SATTERTHWAITE, T. D.; HAJEK, T.; DANNLOWSKI, U.; MALT, U. F.; AROLT, V.; GATTAZ, W. F.; DREVETS, W. C.; CASERAS, X.; AGARTZ, I.; THOMPSON, P. M.; ANDREASSEN, O. A.Despite decades of research, the pathophysiology of bipolar disorder (BD) is still not well understood. Structural brain differences have been associated with BD, but results from neuroimaging studies have been inconsistent. To address this, we performed the largest study to date of cortical gray matter thickness and surface area measures from brain magnetic resonance imaging scans of 6503 individuals including 1837 unrelated adults with BD and 2582 unrelated healthy controls for group differences while also examining the effects of commonly prescribed medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had the strongest effects on left pars opercularis (Cohen's d =-0.293; P = 1.71 x 10(-21)), left fusiform gyrus (d =-0.288; P = 8.25 x 10(-21)) and left rostral middle frontal cortex (d =-0.276; P = 2.99 x 10(-19)). Longer duration of illness (after accounting for age at the time of scanning) was associated with reduced cortical thickness in frontal, medial parietal and occipital regions. We found that several commonly prescribed medications, including lithium, antiepileptic and antipsychotic treatment showed significant associations with cortical thickness and surface area, even after accounting for patients who received multiple medications. We found evidence of reduced cortical surface area associated with a history of psychosis but no associations with mood state at the time of scanning. Our analysis revealed previously undetected associations and provides an extensive analysis of potential confounding variables in neuroimaging studies of BD.