Keywords
deep brain stimulation
neuromodulators
Treatment.
therapeutic effects
How to Cite
Abstract
Introduction: Refractory bipolar disorder is a complex psychiatric condition characterized by persistent manic and depressive episodes that do not respond adequately to conventional treatments, such as mood-stabilizing medications and antidepressants. This condition results in severe functional impairment, with a significant impact on patients' quality of life. Objective: To evaluate the role of neuromodulators and deep brain stimulation in the treatment of refractory bipolar disorder, analyzing their efficacy, mechanisms of action, and safety based on recent studies. Methodology: The research followed the PRISMA checklist guidelines for systematic reviews. Searches were performed in the PubMed, Scielo, and Web of Science databases, using the descriptors "refractory bipolar disorder", "deep brain stimulation", "neuromodulators", "treatment", and "therapeutic effects". The selection of articles was restricted to the last ten years. Inclusion criteria were: clinical studies on the use of DBS in refractory bipolar disorder, research investigating neuromodulators as additional therapies, and articles published in English, Portuguese or Spanish. Studies with small sample sizes, non-systematic reviews and articles that did not present relevant data on the therapeutic effects of these interventions were excluded. Results: The results indicated that both DBS and neuromodulators have shown to be promising therapies in the treatment of refractory bipolar disorder. DBS, especially when targeting the nucleus accumbens and other areas involved in emotional regulation, has been shown to reduce symptoms of mania and depression in several clinical studies. Neuromodulators, such as those affecting the dopaminergic and serotonergic systems, have also shown efficacy in some patients, but with less consistent results. Conclusion: Both deep brain stimulation and neuromodulators have shown potential in the treatment of refractory bipolar disorder, showing improvements in symptom control in patients resistant to conventional treatments. However, more long-term clinical studies are needed to consolidate the evidence of their efficacy and safety, in addition to optimizing treatment protocols.
References
Sanches M, Jorge MR. Transtorno afetivo bipolar: um enfoque transcultural [Transcultural aspects of bipolar disorder]. Braz J Psychiatry. 2004 Oct;26 Suppl 3:54-6. Portuguese. doi: 10.1590/s1516-44462004000700013. Epub 2004 Dec 7. PMID: 15597142.
Fu-I L. Transtorno afetivo bipolar na infância e na adolescência [Bipolar disorder in childhood and adolescence]. Braz J Psychiatry. 2004 Oct;26 Suppl 3(Suppl 3):22-6. doi: 10.1590/s1516-44462004000700006. Epub 2004 Dec 7. PMID: 15597135; PMCID: PMC2194808.
Frey BN, Fonseca MM, Machado-Vieira R, Soares JC, Kapczinski F. Anormalidades neuropatológicas e neuroquímicas no transtorno afetivo bipolar [Neuropatological and neurochemical abnormalities in bipolar disorder]. Braz J Psychiatry. 2004 Sep;26(3):180-8. Portuguese. doi: 10.1590/s1516-44462004000300008. Epub 2004 Nov 17. PMID: 15645064.
Kapczinski F, Frey BN, Zannatto V. Fisiopatologia do transtorno afetivo bipolar: o que mudou nos últimos 10 anos? [Physiopathology of bipolar disorders: what have changed in the last 10 years?]. Braz J Psychiatry. 2004 Oct;26 Suppl 3:17-21. Portuguese. doi: 10.1590/s1516-44462004000700005. Epub 2004 Dec 7. PMID: 15597134.
Meira-Lima IV, Vallada H. Genes relacionados ao metabolismo dos fosfolípides como fatores de risco para o transtorno afetivo bipolar [Genes related to phospholipid metabolism as risk factors related to bipolar affective disorder]. Braz J Psychiatry. 2003 Mar;25(1):51-5. Portuguese. doi: 10.1590/s1516-44462003000100010. PMID: 12975680.
Malloy-Diniz LF, Neves F, Corrêa H. Aspectos neuropsicológicos do transtorno afetivo bipolar [Neuropsychological aspects of bipolar disorder]. Braz J Psychiatry. 2009 Jun;31(2):183-5. Portuguese. doi: 10.1590/s1516-44462009000200018. PMID: 19578694.
Miasso AI, do Carmo BP, Tirapelli CR. Transtorno afetivo bipolar: perfil farmacoterapêutico e adesão ao medicamento [Bipolar affective disorder: pharmacotherapeutic profile and adherence to medication]. Rev Esc Enferm USP. 2012 Jun;46(3):689-95. Portuguese. doi: 10.1590/s0080-62342012000300022. PMID: 22773491.
Vasconcelos AG, Malloy-Diniz LF, Nascimento Ed, Neves F, Corrêa H. Traços de temperamento associados ao transtorno afetivo bipolar: uma revisão integrativa da literatura [Temperament traits associated with bipolar affective disorder: an integrative literature review]. Trends Psychiatry Psychother. 2011;33(3):169-80. Portuguese. doi: 10.1590/s2237-60892011000300007. PMID: 25924090.
Menezes SL, de Mello E Souza MC. Grupo de psicoeducação no transtorno afetivo bipolar: reflexão sobre o modo asilar e o modo psicossocial [Psychoeducational group and bipolar affective disorder: a reflection on the asylum and psychosocial models]. Rev Esc Enferm USP. 2011 Aug;45(4):996-1001. Portuguese. doi: 10.1590/s0080-62342011000400029. PMID: 21876904.
Miasso AI, Cassiani SH, Pedrão LJ. Transtorno afetivo bipolar e a ambivalência em relação à terapia medicamentosa: analisando as condições causais [Affective bipolar disorder and ambivalence in relation to the drug treatment: analyzing the causal conditions]. Rev Esc Enferm USP. 2011 Apr;45(2):433-41. Portuguese. doi: 10.1590/s0080-62342011000200019. PMID: 21655795.
Menezes SL, de Mello E Souza MC. Implicações de um grupo de Psicoeducação no cotidiano de portadores de Transtorno Afetivo Bipolar [The implications of a psychoeducation group on the everyday lives of individuals with bipolar affective disorder]. Rev Esc Enferm USP. 2012 Feb;46(1):124-31. Portuguese. doi: 10.1590/s0080-62342012000100017. PMID: 22441275.
Khafif TC, Kleinman A, Rocca CCA, Belizário GO, Nader E, Caetano SC, Lafer B. Self-regulation in youth with bipolar disorder. Braz J Psychiatry. 2023 Mar 11;45(1):20-27. doi: 10.47626/1516-4446-2022-2668. PMID: 35995462; PMCID: PMC9976910.
Boeira MV, Berni GÁ, Passos IC, Kauer-Sant'Anna M, Kapczinski F. Virginia Woolf, neuroprogression, and bipolar disorder. Braz J Psychiatry. 2017 Jan-Mar;39(1):69-71. doi: 10.1590/1516-4446-2016-1962. Epub 2016 Jun 14. PMID: 27304258; PMCID: PMC7112729.
de Siqueira Rotenberg L, Khafif TC, Miskowiak KW, Lafer B. Social cognition and bipolar disorder: pending questions and unexplored topics. Braz J Psychiatry. 2022 Aug 29;44(6):655-663. doi: 10.47626/1516-4446-2021-2272. PMID: 36709449; PMCID: PMC9851752.
Rocca CC, Lafer B. Alterações neuropsicológicas no transtorno bipolar [Neuropsychological disturbances in bipolar disorder]. Braz J Psychiatry. 2006 Sep;28(3):226-37. Portuguese. doi: 10.1590/s1516-44462006000300016. PMID: 17063223.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Raisa D’ Ricolli Rebouças Rocha, Samuel Felício de Oliveira, Daniela Pereira Procópio, Isabela Ferreira Saddi, Rayner Steven Janse Silva, Lailla Christye Faria Neves, Monique Siqueira de Oliveira Faria, Bruno Silveira Leão, Fernanda Maísa de Melo, Rumeningg Abreu Forti, Camille Cipriano Vanini Tupinambá de Oliveira, Álvaro Trigueiro e Silva