ABLATIVE NEUROSURGICAL APPROACHES AND INVASIVE NEUROMODULATION TECHNIQUES IN THE TREATMENT OF TREATMENT-RESISTANT DEPRESSION: A LITERATURE REVIEW

Abstract

Refractory depression affects approximately 30% of patients with depressive disorders, characterizing a condition resistant to conventional treatments and significantly impacting functionality and quality of life. In this context, ablative neurosurgical approaches and invasive neuromodulation techniques emerge as promising therapeutic alternatives. This study aimed to review the available literature on the efficacy, safety, and innovations of these interventions in the treatment of refractory depression. The review was conducted systematically in the PubMed, Scopus, Web of Science, and SciELO databases, using Boolean operators to combine terms related to refractory depression and neurosurgical techniques, including anterior cingulotomy, limbic leucotomy, anterior capsulotomy, deep brain stimulation, and vagus nerve stimulation. Studies in English, clinical trials, systematic reviews, and case reports with relevant clinical data were included, while pediatric articles, duplicates, or articles without peer review were excluded. The findings demonstrate that ablative techniques have evolved from invasive procedures to more precise and safe approaches, with response rates between 40% and 51%, while invasive neuromodulation, including deep brain stimulation and invasive vagus nerve stimulation, allows for individualized adjustments and reversibility, with clinical responses of 40% to 70%. The integration of advanced neuroimaging, functional connectivity, and minimally invasive technologies indicates a trend towards treatment personalization. It is concluded that these strategies offer effective alternatives for patients with treatment-resistant depression, and it is necessary to expand cohorts, standardize protocols, and explore biomarkers and the brain connectome to optimize therapeutic outcomes.