O Efeito da Eletroestimulação nas Funções Executivas, Metacognição e Regulação Emocional de Adultos com Depressão: Um Estudo Experimental

Conteúdo do artigo principal

Renata Mascarenhas Aleixo Reis
https://orcid.org/0000-0002-0840-4355
Tiago da Silva Lopes
José Neander Silva Abreu
https://orcid.org/0000-0001-7636-3666

Resumo

Estudos com estimulação elétrica transcraniana têm demonstrado que há redução na sintomatologia depressiva, mas ainda não está claro se esse tipo de intervenção pode melhorar também funções cognitivas e estratégias de regulação emocional na depressão maior. Este estudo examinou os efeitos da estimulação transcraniana por corrente contínua (ETCC) sobre o córtex pré-frontal dorsolateral nas funções executivas, metacognição de pensamentos e sentimentos e na regulação emocional. Dezoito adultos entre 18 e 40 anos de idade diagnosticados com depressão maior foram aleatoriamente designados para estimulação ativa (N = 10) ou simulada (N = 8). Cada participante foi submetido a dez sessões de ETCC ativa ou simulada por duas semanas. A gravidade dos sintomas de depressão, as funções executivas, a metacognição e as estratégias de regulação emocional dos participantes foram avaliadas no início, imediatamente após a intervenção e três meses após a intervenção. Foi possível observar que a ETCC ativa não teve um maior efeito sobre as variáveis em comparação com a intervenção sham. Ambos os grupos aumentaram a frequência da regulação de pensamentos e sentimentos ao longo do tempo e diminuíram os sintomas depressivos após a intervenção. Os efeitos não significativos da ETCC nas variáveis avaliadas são discutidos à luz de estudos prévios, que apresentam resultados mistos, corroborando e contrastando com os achados aqui encontrados.

Downloads

Não há dados estatísticos.

Detalhes do artigo

Seção
Psicologia Clínica

Referências

Aleixo, R., Bessa, J. R., & Abreu, N. (2022). Construção e Validação da Escala de Metacognição de Pensamentos e Sentimentos. Revista Iberoamericana de Diagnóstico y Evaluación – e Avaliação Psicológica RIDEP, 64(3), 71-80. https://doi.org/10.21865/RIDEP64.3.06

Ambrosini, A., & Coppola, G. (2020). Transcranial direct current stimulation. In Neuromodulation in Headache and Facial Pain Management: Principles, Rationale and Clinical Data (pp. 111-118). https://doi.org/10.1007/978-3-030-14121-9_8

Aparício, L. V., Rosa, V., Razza, L. M., Sampaio-Junior, B., Borrione, L., Valiengo, L., ... & Brunoni, A. R. (2019). Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up. Depression and Anxiety, 36(3), 262-268. https://doi.org/10.1002/da.22878

Barnhofer, T., Reess, T., Fissler, M., Winnebeck, E., Grimm, S., Gärtner, M., ... & Bajbouj, M. (2019). Effects of mindfulness training on emotion regulation in patients with depression: Reduced dorsolateral prefrontal cortex activation indexes early beneficial changes. Psychosomatic Medicine, 81(9), 818-828. https://doi.org/10.1097/PSY.0000000000000955

Brennan, S., McLoughlin, D. M., O’Connell, R., Bogue, J., O’Connor, S., McHugh, C., & Glennon, M. (2017). Anodal transcranial direct current stimulation of the left dorsolateral prefrontal cortex enhances emotion recognition in depressed patients and controls. Journal of Clinical and Experimental Neuropsychology, 39(4), 384-395. https://doi.org/10.1080/13803395.2016.1230595

Brunoni, A. R., Amadera, J., Berbel, B., Volz, M. S., Rizzerio, B. G., & Fregni, F. (2011). A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. International Journal of Neuropsychopharmacology, 14(8), 1133-1145. https://doi.org/10.1017/S1461145710001690

Brunoni, A. R., Tortella, G., Benseñor, I. M., Lotufo, P. A., Carvalho, A. F., & Fregni, F. (2016). Cognitive effects of transcranial direct current stimulation in depression: Results from the SELECT-TDCS trial and insights for further clinical trials. Journal of Affective Disorders, 202, 46-52. https://doi.org/10.1016/j.jad.2016.03.066

Brunoni, A. R., Sampaio-Junior, B., Moffa, A. H., Aparício, L. V., Gordon, P., Klein, I., ... & Valiengo, L. (2018). Noninvasive brain stimulation in psychiatric disorders: A primer. Brazilian Journal of Psychiatry, 41, 70-81. https://doi.org/10.1590/1516-4446-2017-0018

Brunoni, A. R., Valiengo, L., Baccaro, A., Zanão, T. A., Oliveira, J. F. de, Goulart, A., ... & Fregni, F. (2013). The sertraline vs electrical current therapy for treating depression clinical study. JAMA Psychiatry, 70(4), 383-391. https://doi.org/10.1001/2013.jamapsychiatry.32

Cash, R. F., Cocchi, L., Lv, J., Fitzgerald, P. B., & Zalesky, A. (2021). Functional magnetic resonance imaging– guided personalization of transcranial magnetic stimulation treatment for depression. JAMA Psychiatry, 78(3), 337-339. https://doi.org/10.1001/jamapsychiatry.2020.3794

Chrysikou, E. G., Wing, E. K., & van Dam, W. O. (2022). Transcranial direct current stimulation over the prefrontal cortex in depression modulates cortical excitability in emotion regulation regions as measured by concurrent functional magnetic resonance imaging: An exploratory study. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 7(1), 85-94. https://doi.org/10.1016/j.bpsc.2019.12.004

Chua, E. F., Ahmed, R., & Garcia, S. M. (2017). Effects of HD-tDCS on memory and metamemory for general knowledge questions that vary by difficulty. Brain Stimulation, 10(2), 231-241. https://doi.org/10.1016/j.brs.2016.10.013

Doruk, D., Gray, Z., Bravo, G. L., Pascual-Leone, A., & Fregni, F. (2014). Effects of tDCS on executive function in Parkinson’s disease. Neuroscience Letters, 582, 27-31. https://doi.org/10.1016/j.neulet.2014.08.043

Duggan, M. C., Wang, L., Wilson, J. E., Dittus, R. S., Ely, E. W., & Jackson, J. C. (2017). The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: Results from the BRAIN-ICU investigation. Journal of Critical Care, 37, 72-79. https://doi.org/10.1016/j.jcrc.2016.08.023

Fergusson, D., Aaron, S. D., Guyatt, G., & Hébert, P. (2002). Post-randomisation exclusions: The intention to treat principle and excluding patients from analysis. BMJ, 325(7365), 652-654. https://doi.org/10.1136/bmj.325.7365.652

Flournoy, J., & O’Hara, R. M. (2016). The impact of executive function on response to cognitive behavioral therapy in late‐life depression. International Journal of Geriatric Psychiatry, 31(4), 334-339. https://doi.org/10.1002/gps.4325

Fregni, F., El-Hagrassy, M. M., Pacheco-Barrios, K., Carvalho, S., Leite, J., Simis, M., ... & Brunoni, A. R. (2021). Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation in neurological and psychiatric disorders. International Journal of Neuropsychopharmacology, 24(4), 256-313. https://doi.org/10.1093/ijnp/pyaa051

Goodkind, M. S., Gallagher-Thompson, D., Thompson, L. W., Kesler, S. R., Anker, L., Ilieva, I. P., ... & Gunning, F. M. (2018). Age-related repetitive transcranial magnetic stimulation effects on executive function in depression: A systematic review. The American Journal of Geriatric Psychiatry, 26(3), 334-346. https://doi.org/10.1016/j.jagp.2017.09.002

Gouveia, V. V., Moura, H. M. D., Oliveira, I. C. V. D., Ribeiro, M. G. C., Rezende, A. T., & Brito, T. R. D. S. (2018). Emotional regulation questionnaire (ERQ): Evidence of construct validity and internal consistency. Psico-USF, 23, 461-471. https://doi.org/10.1590/1413-82712018230306

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348. https://doi.org/10.1037/0022-3514.85.2.348

Gruber, M., Mauritz, M., Meinert, S., Grotegerd, D., de Lange, S. C., Grumbach, P., ... & Repple, J. (2023). Cognitive performance and brain structural connectome alterations in major depressive disorder. Psychological Medicine, 1-12. https://doi.org/10.1017/S0033291722004007

Gupta, S. K. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2(3), 109. https:// doi.org/10.4103/2229-3485.83221

Hjemdal, O., Solem, S., Hagen, R., Kennair, L. E. O., Nordahl, H. M., & Wells, A. (2019). A randomized controlled trial of metacognitive therapy for depression: Analysis of 1-year follow-up. Frontiers in Psychology, 10, 1842. https://doi.org/10.3389/fpsyg.2019.01842

Imburgio, M. J., & Orr, J. M. (2018). Effects of prefrontal tDCS on executive function: Methodological considerations revealed by meta-analysis. Neuropsychologia, 117, 156-166. https://doi.org/10.1016/j.neuropsicologia.2018.04.022

Jelinek, L., Faissner, M., Moritz, S., & Kriston, L. (2019). Long-term efficacy of Metacognitive Training for Depression (D-MCT): A randomized controlled trial. British Journal of Clinical Psychology, 58(3), 245-259. https://doi.org/10.1111/bjc.12213

Jog, M. A., Anderson, C., Kubicki, A., & Boucher, M. (2023). Transcranial direct current stimulation (tDCS) in depression induces structural plasticity. Scientific Reports, 13, 2841. https://doi.org/10.1038/s41598-023-29792-6

Jog, M., Taraku, B., Boucher, M., Hellemann, G., Narr, K., & Woods, R. (2022). P342. Modulation of Depression-Relevant Circuitry by Transcranial Direct Current Stimulation (tDCS). Biological Psychiatry, 91(9), S225-S226. https://doi.org/10.1016/j.biopsych.2022.02.578

Joormann, J., & Stanton, C. H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86, 35-49. https://doi.org/10.1016/j.brat.2016.07.007

Joormann, J., & Vanderlind, W. M. (2014). Emotion regulation in depression: The role of biased cognition and reduced cognitive control. Clinical Psychological Science, 2(4), 402-421. https://doi.org/10.1177/2167702614536163

Kumar, S., Batist, J., Ghazala, Z., Zomorrodi, R. M., Brooks, H., Goodman, M., ... & Rajji, T. K. (2020). Effects of bilateral transcranial direct current stimulation on working memory and global cognition in older patients with remitted major depression: A pilot randomized clinical trial. International Journal of Geriatric Psychiatry, 35(10), 1233-1242. https://doi.org/10.1002/gps.5361

Lezama, R., Gómez-Ariza, C. J., & Bajo, M. T. (2024). Dissociating semantic integration and inhibitory control in the Remote Associates Test: A tDCS-EEG study. Creativity Research Journal, *36*(3), 1–27. https://doi.org/10.1080/10400419.2024.2373593

Li, Z., Chen, J., Feng, Y., Zhong, S., Tian, S., Dai, Z., ... & Jia, Y. (2021). Differences in verbal and spatial working memory in patients with bipolar II and unipolar depression: An MSI study. BMC Psychiatry, 21(1), 1-11. https://doi.org/10.1186/s12888-021-03595-3

Loo, C. K., Alonzo, A., Martin, D., Mitchell, P. B., Galvez, V., & Sachdev, P. (2012). Transcranial direct current stimulation for depression: 3-week randomised sham-controlled trial. The British Journal of Psychiatry, 200(1), 52-59. https://doi.org/10.1192/bjp.bp.111.097634

Marković, V., Vicario, C. M., Yavari, F., Salehinejad, M. A., & Nitsche, M. A. (2021). A systematic review on the effect of transcranial direct current and magnetic stimulation on fear memory and extinction. Frontiers in Human Neuroscience. https://doi.org/10.3389/fnhum.2021.655947

Marques, L. M., Morello, L. Y., & Boggio, P. S. (2018). Ventrolateral but not dorsolateral prefrontal cortex tDCS effectively impact emotion reappraisal–effects on emotional experience and interbeat interval. Scientific Reports, 8(1), 15295. https://doi.org/10.1038/s41598-018-33711-5

Martin, D. M., Moffa, A., Nikolin, S., Bennabi, D., Brunoni, A. R., Flannery, W., ... & Loo, C. K. (2018). Cognitive effects of transcranial direct current stimulation treatment in patients with major depressive disorder: An individual patient data meta-analysis of randomised sham-controlled trials. Neuroscience & Biobehavioral Reviews, 90, 137-145. https://doi.org/10.1016/j.neubiorev.2018.04.008

Masuda, F., Nakajima, S., Miyazaki, T., Tarumi, R., Ogyu, K., Wada, M., ... & Noda, Y. (2019). Clinical effectiveness of repetitive transcranial magnetic stimulation treatment in children and adolescents with neurodevelopmental disorders: A systematic review. Autism, 23(7), 1614-1629. https://doi.org/10.1177/1362361318822502

Moffa, A. H., Martin, D., Alonzo, A., Bennabi, D., Blumberger, D. M., Benseñor, I. M., ... & Brunoni, A. R. (2020). Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109836. https://doi.org/10.1016/j.pnpbp.2019.109836

Mutz, J., Edgcumbe, D. R., Brunoni, A. R., & Fu, C. H. (2018). Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials. Neuroscience & Biobehavioral Reviews, 92, 291-303. https://doi.org/10.1016/j.pnpbp.2019.109836

Nardo, D., Creasey, M., Negus, C., Pappa, K., Aghaeifar, A., Reid, A., Josephs, O., Callaghan, M. F., & Crinion, J. T. (2023). Transcranial direct current stimulation with functional magnetic resonance imaging: A detailed validation and operational guide. Wellcome Open Research, 6, 143. https://doi.org/10.12688/wellcomeopenres.16679.2

Narmashiri, A., & Akbari, F. (2025). The effects of transcranial direct current stimulation (tDCS) on cognitive functions: A systematic review and meta-analysis. Neuropsychology Review, 35, 126–152. https://doi.org/10.1007/s11065-023-09627-x

Nikolin, S., Moffa, A., Razza, L., Martin, D., Brunoni, A. R., Palm, U., Padberg, F., Bennabi, D., Haffen, E., Blumberger, D. M., Salehinejad, M. A., & Loo, C. K. (2023). Time-course of the tDCS antidepressant effect: An individual participant data meta-analysis. *Progress in Neuro-Psychopharmacology and Biological Psychiatry, 125*, 110752. https://doi.org/10.1016/j.pnpbp.2023.110752

Oathes, D. J., Balderston, N. L., Kording, K. P., DeLuisi, J. A., Perez, G. M., Medaglia, J. D., ... & Linn, K. A. (2021). Combining transcranial magnetic stimulation with functional magnetic resonance imaging for probing and modulating neural circuits relevant to affective disorders. Wiley Interdisciplinary Reviews: Cognitive Science, 12(4), e1553. https://doi.org/10.1002/wcs.1553

Palm, U., Schiller, C., Fintescu, Z., Obermeier, M., Keeser, D., Reisinger, E., ... & Padberg, F. (2012). Transcranial direct current stimulation in treatment resistant depression: A randomized double-blind placebo-controlled study. Brain Stimulation, 5(3), 242-251. https://doi.org/10.1016/j.brs.2011.08.005

Philip, N. S., Barredo, J., Aiken, E., & Carpenter, L. L. (2018). Neuroimaging mechanisms of therapeutic transcranial magnetic stimulation for major depressive disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(3), 211-222. https://doi.org/10.1016/j.bpsc.2017.10.007

Razza, L. B., Moffa, A. H., Moreno, M. L., Carvalho, A. F., Padberg, F., Fregni, F., & Brunoni, A. R. (2018). A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 81, 105-113. https://doi.org/10.1016/j.pnpbp.2017.10.016

Razza, L. B., Palumbo, P., Moffa, A. H., Carvalho, A. F., Solmi, M., Loo, C. K., & Brunoni, A. R. (2020). A systematic review and meta-analysis on the effects of transcranial direct current stimulation in depressive episodes. Depression and Anxiety, 37(7), 594-608. https://doi.org/10.1002/da.23004

Rezaei, M., Bagheri, M. M. S., & Ahmadi, M. (2021). Clinical and demographic predictors of response to anodal tDCS treatment in major depression disorder (MDD). Journal of Psychiatric Research, 138, 68-74. https://doi.org/10.1016/j.jpsychires.2021.03.047

Shimony, O., Einav, N., Bonne, O., Jordan, J. T., Van Vleet, T. M., & Nahum, M. (2021). The association between implicit and explicit affective inhibitory control, rumination and depressive symptoms. Scientific Reports, 11(1), 1-13. https://doi.org/10.1038/s41598-021-90875-3

Smet, S., Nikolin, S., Moffa, A., Suen, P., Vanderhasselt, M. A., Brunoni, A. R., & Razza, L. B. (2021). Determinants of sham response in tDCS depression trials: A systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109, 110261. https://doi.org/10.1016/j.pnpbp.2021.110261

Trivedi, M. H., & Greer, T. L. (2014). Cognitive dysfunction in unipolar depression: Implications for treatment. Journal of Affective Disorders, 152, 19-27. https://doi.org/10.1016/j.jad.2013.09.012

Vanderlind, W. M., Millgram, Y., Baskin-Sommers, A. R., Clark, M. S., & Joormann, J. (2020). Understanding positive emotion deficits in depression: From emotion preferences to emotion regulation. Clinical Psychology Review, 76, 101826. https://doi.org/10.1016/j.cpr.2020.101826

Vilgis, V., Gelardi, K. L., Helm, J. L., Forbes, E. E., Hipwell, A. E., Keenan, K., & Guyer, A. E. (2018). Dorsomedial prefrontal activity to sadness predicts later emotion suppression and depression severity in adolescent girls. Child Development, 89(3), 758-772. https://doi.org/10.1111/cdev.13023

Wong, H. L., Chan, W. C., Wong, Y. L., Wong, S. N., Yung, H. Y., Wong, S. M. C., & Cheng, P. W. C. (2019). High‐definition transcranial direct current stimulation—An open‐label pilot intervention in alleviating depressive symptoms and cognitive deficits in late‐life depression. CNS Neuroscience & Therapeutics, 25(11), 1244-1253. https://doi.org/10.1111/cns.13253

Woodham, R., Rimmer, R. M., Mutz, J., & Fu, C. H. (2021). Is tDCS a potential first line treatment for major depression? International Review of Psychiatry, 33(3), 250-265. https://doi.org/10.1080/09540261.2021.1879030

Zhang, Q., Li, X., Liu, X., Liu, S., Zhang, M., Liu, Y., ... & Wang, K. (2022). The effect of non-invasive brain stimulation on the downregulation of negative emotions: A meta-analysis. Brain Sciences, 12(6), 786. https://doi.org/10.3390/brainsci12060786

Zheng, E. Z., Wong, N. M. L., Yang, A. S. Y, & Lee, T. M. C. (2024). Evaluating the effects of tDCS on depressive and anxiety symptoms from a transdiagnostic perspective: a systematic review and meta-analysis of randomized controlled trials. Transl Psychiatry, 14(1), 295. https://doi.org/10.1038/s41398-024-03003-w

Zhou, H., Dang, L., Lam, L. W., Zhang, M. X., & Wu, A. M. (2021). A cross-lagged panel model for testing the bidirectional relationship between depression and smartphone addiction and the influences of maladaptive metacognition on them in Chinese adolescents. Addictive Behaviors, 120, 106978. https://doi.org/10.1016/j.addbeh.2021.106978