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Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis

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dc.contributor.advisorReyes, Juan Manuel
dc.contributor.advisorFierro Urresta, Marco Aurelio
dc.creatorRada Pineda, Alvaro Javier
dc.creator.degreeEspecialista en Psiquiatría
dc.date.accessioned2016-02-10T19:49:40Z
dc.date.available2016-02-10T19:49:40Z
dc.date.created2016-01-08
dc.date.issued2016
dc.descriptionResumen Introducción Una posible opción de tratamiento para el manejo del trastorno depresivo mayor (TDM) es la estimulación magnética transcraneal (EMT) que ha mostrado propiedades antidepresivas superiores al placebo con un buen perfil de seguridad. El objetivo del presente trabajo es determinar la reducción en la severidad del TDM y la proporción de eventos adversos (EA) en pacientes con TDM refractario y no refractario, posterior al uso de EMT administrada en monoterapia o tratamiento coadyuvante comparado con terapia farmacológica. Metodología Se planteó una pregunta PICOT de la cual se realizó una búsqueda sistemática de estudios clínicos en las bases de datos Medline, EMBASE y Cochrane. Dos investigadores en forma independiente realizaron la selección de artículos, evaluación de calidad con la herramienta de la colaboración Cochrane y extracción de datos. Se extrajeron datos de eficacia como tasa de respuesta, porcentaje de remisión, calidad de vida, diminución sintomática del trastorno depresivo mayor en la escala de Hamilton y capacidad funcional. Igualmente, proporción de pacientes con EA. Se realizó un meta-análisis de estas variables teniendo en cuenta la heterogeneidad. Resultados La presente revisión sistemática incluyó 26 estudios clínicos aleatorizados de baja calidad metodológica mostrando que la EMT presentó una eficacia superior cuando es usada como coadyuvante a las terapias con que venían siendo tratados los pacientes con TDM refractario y no refractario en los desenlaces de tasa de respuesta y porcentaje de remisión. En el caso de intervenciones farmacológicas específicas, la EMT presento eficacia similar, tanto en terapia coadyuvante como en monoterapia comparado con las intervenciones farmacológicas. En cuanto a seguridad, la EMT presenta un buen perfil de seguridad debido a que en todos los escenarios estudiados los EA fueron no serios y baja frecuencia Conclusiones La evidencia disponible sugiere que la EMT mostró ser efectivo y seguro para el manejo del TDM refractario y no refractario. Sin embargo, la evidencia es débil por lo tanto se necesita mayor investigación clínica que soporte su uso.spa
dc.description.abstractAbstract Introduction One possible treatment option for the management of major depressive disorder (MDD) is transcranial magnetic stimulation (TMS) which has shown antidepressant properties superior to placebo with a good safety profile. The aim of this study is to determine the reduction in the severity of MDD and proportion of adverse events (AEs) in patients with refractory and non-refractory MDD, following the use of TMS administered as monotherapy or adjunctive therapy compared to pharmacological therapy. Methodology A systematic search of a PICOT question was performed in the Medline, EMBASE and Cochrane database. Two investigators independently selected citations, assessed of quality using Cochrane Collaboration tool and collected the data. Efficacy data were extracted such as response rate, remission rate, quality of life, symptoms decrease of major depressive disorder in the Hamilton scale and functional capacity. Similarly, proportion of patients with AEs. A meta-analysis of these variables was performed taking into account the heterogeneity. Results This systematic review included 26 randomized trials with low methodological quality showing that TMS had superior efficacy when was used as an adjunct to therapies that were being treated patients with refractory MDD and non-refractory in the outcomes of response rate and percentage of remission. In the case of specific pharmacological interventions, TMS has similarly effective in both monotherapy and adjunctive therapy compared to pharmacological interventions. Regarding to safety, the TMS had a good safety profile because in all scenarios studied the AE were not serious and low frequency Conclusions The available evidence suggests that TMS show to be effective and safe for the management of refractory and non-refractory MDD. However, the evidence is weak therefore major clinical research is necessary in order to support its use.eng
dc.description.sponsorshipUniversidad del Rosariospa
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dc.identifier.doihttps://doi.org/10.48713/10336_11711
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/11711
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Psiquiatríaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto completo)spa
dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectEstimulacion Magnetica Transcranealspa
dc.subjectTrastorno depresivo mayorspa
dc.subject.ddcPsicología
dc.subject.decsEstimulación magnética transcranealspa
dc.subject.decsDepresiónspa
dc.subject.decsMedicina de la conductaspa
dc.subject.decsUtilización de medicamentosspa
dc.subject.keywordTranscranial Magnetic Stimulationeng
dc.subject.keywordmajor depressive disordereng
dc.subject.lembPsicologíaspa
dc.titleEficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisisspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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