Barcelona snapshots

Prof. Frank Padberg

Frank Padberg psiquiatra Controversies Psiquiatria Barcelona
Ludwig-Maximilians-Universität München, Alemanya
Ponència Neuromodulació, integració amb altres teràpies
Data Divendres, 11 d'abril de 2025
Hora 17:45 - 18:30
Taula rodona Innovació en Neuromodulació

BIOGRAFIA

Frank Padberg is Director of the Center for Non-invasive Brain Stimulation Munich Augsburg (CNBSMA), the Psychotherapy and Social Neuroscience Research Unit and the Section of Psychosomatic Medicine and Psychotherapy at the Dept. of Psychiatry and Psychotherapy, LMU Hospital Munich. His research focus is on the development of non-pharmacological interventions for complex affective disorders, i.e. persistent depressive disorder or depression with significant psychiatric co-morbidities (e.g. borderline personality disorder). He and his co-workers are currently following different lines of research: 1) understanding the complexity of affective disorders by characterizing clinical, psychosocial (e.g. trauma, resilience, attachment, loneliness) and neurobiological features in affective disorders, 2) investigating mechanisms-based psychotherapy (e.g. CBASP), and 3) developing non-invasive brain stimulation (NIBS) methods (e.g. rTMS and tDCS) to provide safe and effective therapeutic interventions. Frank Padberg widely contributed to the respective research fields (e.g. see google scholar: h-index: 75, i10-index: 247, 33000 citations).

RESUM

Neuromodulation has emerged as a promising therapeutic approach in psychiatry, particularly for treatment-resistant psychiatric disorders. It involves the targeted neurophysiological modulation of neural circuits by techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). Some of these methods have proven efficacy in mental disorders including major depressive disorder (MDD), schizophrenia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Brain stimulation interventions follow two prevailing therapy models: A) acute treatment model which underlies non-invasive brain stimulation (NIBS) interventions as rTMS and tDCS, i.e. with repeated sessions for 1 to 10 weeks, which may be extended towards maintenance therapy, and B) a 24x7 long-term treatment (VNS and DBS). Both models are strongly rooted in pragmatic aspects of the respective method, e.g. a single sessions setting of NIBS interventions and the natural long-term application of implanted stimulation. Particularly rTMS is becoming established in mental health care, but also tDCS, VNS and DBS may be relevant treatment options for individual people. Therefore, new challenges as well as opportunities arise from integrating neuromodulation with other therapies.

Combining neuromodulation with pharmacological treatments may theoretically enhance therapeutic efficacy and reduce medication-related side effects. In depression, selective serotonin reuptake inhibitors (SSRIs) have been shown to exert antidepressant effects in synergy with tDCS of the dorsolateral prefrontal cortex (DLPFC), though adding tDCS to an ongoing SSRI medication was not successful (Burkhardt et al. 2023). In contrast, DLPFC rTMS has been reported to be even superior in comparison with aripiprazole or venlafaxine/duloxetine, when initial antidepressant treatments have failed and therapy-resistant depression (TRD) evolved (Papakostas et al. 2024). However, these are just first steps in the long-term challenge to systematically establish therapeutic neuromodulation in stepped-care or stratified treatment algorithms. Neuromodulation may also enhance the effectiveness of psychotherapeutic interventions by promoting neuroplasticity and targeting (dys)functional connectivity. In posttraumatic stress disorder (PTSD), active tDCS combined with virtual reality (VR) based exposure therapy showed a superior reduction in self-reported PTSD symptom severity at one month as compared with sham rTMS (an ‘t Wout-Frank et al. 2024. Moreover, tDCS can be easily combined with group psychotherapy (Aust et al. 2023), however, this approach has not proven superior efficacy as compared to group psychotherapy alone in adults with major depression. Psychotherapy may offer advantages in focusing on specific constellations, e.g. chronic depression with previous child maltreatment (Goerigk et al. 2024), which is also related to TRD. Thus, it may be more promising to investigate neuromodulation with mechanism based psychological interventions including concurrent cognitive or behavioral training (Dechantsreiter et al. 2023). These ideas converge with recent findings that rTMS of brain targets as the DLPFC may not only work in distinct disorders, but rather on transdiagnostic domains, e.g. craving and depression (Kan et al. 2023).

Despite its therapeutic potential, the integration of neuromodulation in multimodal mental health care settings is essential and faces challenges, including variability in patient response, high costs, and the need for specialized expertise in administration. Ongoing research and technological innovations hold the potential to further optimize neuromodulation-based interventions, paving the way for more individualized and effective psychiatric treatments.

REFERÈNCIES