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The Scope of the Problem

Neuropsychiatric disorders are significant public health problems. They cause suffering, increase mortality and morbidity. These disorders, including major depressive disorder, obsessive-compulsive disorder, Post-traumatic stress disorder, Parkinson’s disease, Essential tremor, Dystonias and epilepsy, are a major cause of disability. Major depressive disorder (MDD) affects about 10% of the population and is one of the leading causes of disability worldwide.  In addition to being underdiagnosed and undertreated, major depressive disorder treatment can pose a clinical challenge. Existing treatment modalities including medication and non-medication treatments for neuropsychiatric disorders are suboptimal due to problems of tolerability, inadequate resolution of symptoms, and lack of specificity. Treatment resistant depression (TRD) is another example and aspect of this problem and disease burden. It is a significant clinical problem found in 29%-46% of depressed patients treated with standard-dose antidepressants for at least six weeks.  There is need to develop and implement newer and more effective treatments for treatment resistant depression in addition to changing prescribed antidepressants, augmentation, and neuromodulation techniques, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). Various brain stimulation therapies, other than ECT, include transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), and deep brain stimulation (DBS), have been shown to be effective in clinical trials. Neuromodulation techniques are novel and fill in these gaps in the treatment of various neuropsychiatric disorders.

 References

  1. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. J Clin Psychiatry. 2018 ; 79(1): doi:10.4088/JCP.16cs10905
  2. Khurshid KA. Neuromodulation in Neuropsychiatric Disorders, Psychiatric Annals. 2016;46(11):626-628
  3. Rush AJ, Trivedi MH, Wisniewski SR et al. Acute and Longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR D report. Am J Psychiatry 2006; 163: 1905-1917
  4. Janicak PG, Dowd SM, Rado JT and Welch MJ. The emerging role of therapeutic neuromodulation. Current Psychiatry 2010; 9(11): 66-74 
  5. Naha Z, Short B, Burns C et al. A feasibility study of a new method for electrically producing seizure in man: focal electrically administered seizure therapy (FEAST). Brain Stmul 2013; 6(30): 403-408