Igor D. Bandeira, M.D., Ph.D., is a physician-scientist from Salvador in Brazil, working as a Postdoctoral Research Fellow in the Department of Psychiatry and Behavioral Sciences at Stanford University. He completed his Doctor of Medicine (M.D.) at the Federal University of Bahia (Brazil), where he received the prestigious Professor Alfredo Thomé de Britto Award for outstanding graduate scientific research. Part of his medical training took place at the University of Sydney (Australia) through a Science Without Borders Scholarship. In parallel with his formal graduate training, he worked as a researcher at the university’s Brain and Mind Centre during this period. As an attending physician, Dr. Bandeira acquired further clinical experience at the Brazilian Ministry of Health. Furthermore, during the pandemic, Dr. Bandeira worked on the Brazilian frontline in the fight against Covid-19. With respect to research, he has several years’ experience applying noninvasive brain stimulation techniques in the fields of neurology and psychiatry. During his Ph.D. at the Federal University of Bahia, Dr. Bandeira has also acquired expertise in developing clinical trials to test the efficacy of rapid-acting antidepressants. His work involved using ketamine and its enantiomers (e.g., esketamine and arketamine) for treatment-resistant depression (TRD) and bipolar depression. Since he arrived at Stanford, he has built on his previous training in clinical trials by leading (A) the Wellcome LEAP multisite accelerated intermittent theta burst stimulation (Stanford Neuromodulation Therapy) trial for anhedonic depression and co-leading (B) a trial testing the efficacy and safety of buprenorphine in sustaining the anti-suicide properties of ketamine.

Honors & Awards

  • New Investigator Award, American Society of Clinical Psychopharmacology (2024)
  • Scholarship Award, American Psychopathological Association (2024)
  • Travel Award, American Society of Hispanic Psychiatry (2024)
  • Travel Fellowship Award, Society of Biological Psychiatry (2023)
  • Postgraduate Research Fellowship, Coordination for the Improvement of Higher Education Personnel (2019)
  • Professor Alfredo Thomé de Britto Award, Federal University of Bahia (2018)
  • Oral Presentation Award, IX International Symposium in Neuromodulation (2017)
  • Science without Borders Scholarship, National Council for Technological and Scientific Development (2016)
  • Research Scholarship Award, National Council for Technological and Scientific Development (2015)
  • Research Scholarship Award, Federal University of Bahia (2014)
  • Research Scholarship Award, Federal University of Bahia (2013)
  • Third Best Oral Presentation, Brazilian Academy of Neurology (2013)

Professional Education

  • Doctor of Medicine, Universidade Federal da Bahia (2018)
  • Doctor of Philosophy, Universidade Federal da Bahia (2021)

Stanford Advisors

All Publications

  • Esketamine Augmentation in Treatment-Resistant Obsessive-Compulsive Disorder: A Retrospective Chart Review. Clinical neuropharmacology Alves-Pereira, R., Fontes, M., Cordeiro, V., Bandeira, I. D., Faria-Guimarães, D., Silva, S. S., Mello, R. P., Leal, G. C., Sampaio, A. S., Quarantini, L. C. 2024


    Converging evidence supports the role of the glutamate, an excitatory amino acid neurotransmitter, in the pathophysiology of obsessive-compulsive disorder (OCD). Ketamine and esketamine, both noncompetitive N-methyl-d-aspartate antagonists, have emerged as a promising medication for this psychiatric disorder, given its possible efficacy with faster onset and good tolerability. The purpose of this retrospective chart review is to evaluate whether unbiased clinical documentation supports formal clinical trials of esketamine for an OCD indication.A retrospective chart review of patients with treatment-resistant OCD receiving a single dose of esketamine (0.5mg/kg) added to standard therapy was conducted. The Yale-Brown Obsessive-Compulsive Scale and the Montgomery-Åsberg Depression Rating Scale were used to evaluate OCD and depressive symptoms respectively at baseline, 24 hours, and 7 days after esketamine administration. Descriptive statistics were used to analyze the data.Eight subjects were identified in this retrospective chart review: esketamine was administered subcutaneously in 7 and intravenously in 1. One week after infusion, 25% of the sample met criteria for treatment response and 50% for partial response. Major depressive disorder was a comorbid diagnosis in 75% of the sample and 2 of these subjects showed a positive antidepressant response.Our findings provide preliminary evidence that esketamine may reduce obsessive-compulsive symptoms in a subset of treatment-resistant OCD patients.

    View details for DOI 10.1097/WNF.0000000000000578

    View details for PubMedID 38194244

  • Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine and esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial. Trends in psychiatry and psychotherapy Echegaray, M. V., Mello, R. P., Magnavita, G. M., Leal, G. C., Correia-Melo, F. S., Jesus-Nunes, A. P., Vieira, F., Bandeira, I. D., Caliman-Fontes, A. T., Telles, M., Guerreiro-Costa, L. N., Marback, R. F., Souza-Marques, B., Lins-Silva, D. H., Santos-Lima, C., Cardoso, T. d., Kapczinski, F., Lacerda, A. L., Quarantini, L. C. 2023


    Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD), and conflicting evidence suggests that induced dissociation by these drugs can be a clinical predictor of esketamine/ketamine's efficacy.This study is a secondary analysis from a bi-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of esketamine (.25 mg/kg) or racemic ketamine (.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. The variation in depression scores was measured with the Montgomery-Asberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hrs, 72 hrs, and 7 days following infusion.Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of -0.5 (SD = 0.25; p-value 0.04) of predicted MADRS score from baseline to 24 hrs. The results for 72 hrs and 7 days following infusion were not significant. Limitations: This study was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, therefore confounding variables for this relationship were not controlled.We suggest a positive relationship between dissociation intensity, measured by CADSS, and antidepressant effect 24 hours after ketamine and esketamine infusion for a CADSS score of up to 15 points.

    View details for DOI 10.47626/2237-6089-2022-0593

    View details for PubMedID 37717263

  • Arketamine for bipolar depression: Open-label, dose-escalation, pilot study. Journal of psychiatric research Bandeira, I. D., Leal, G. C., Correia-Melo, F. S., Souza-Marques, B., Silva, S. S., Lins-Silva, D. H., Mello, R. P., Vieira, F., Dorea-Bandeira, I., Faria-Guimarães, D., Carneiro, B., Caliman-Fontes, A. T., Kapczinski, F., Miranda-Scippa, Â., Lacerda, A. L., Quarantini, L. C. 2023; 164: 229-234


    There are significantly fewer options for the treatment of bipolar depression than major depressive disorder, with an urgent need for alternative therapies. In this pilot study, we treated six subjects with bipolar disorder types I and II (according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria) who had been in a current depressive episode for at least four weeks. Four subjects were female (66.66%), and the mean age was 45.33 (±12.32). Subjects received adjunct treatment with two arketamine intravenous infusions one week apart-0.5 mg/kg first and then 1 mg/kg. The mean baseline Montgomery-Åsberg Depression Rating Scale (MADRS) total score was 36.66, which decreased to 27.83 24h after the first infusion of 0.5 mg/kg of arketamine (p = 0.036). In respect of the 1 mg/kg dose, the mean MADRS total score before the second infusion was 32.0, which dropped to 17.66 after 24h (p < 0.001). Arketamine appears to have rapid-acting antidepressant properties, consistent with previous animal studies on major depression. All individuals tolerated both doses, exhibiting nearly absent dissociation, and no manic symptoms. To the best of our knowledge, this pilot trial is the first to test the feasibility and safety of the (R)-enantiomer of ketamine (arketamine) for bipolar depression.

    View details for DOI 10.1016/j.jpsychires.2023.06.028

    View details for PubMedID 37385001

  • Taking modern psychiatry into the metaverse: Integrating augmented, virtual, and mixed reality technologies into psychiatric care. Frontiers in digital health Ford, T. J., Buchanan, D. M., Azeez, A., Benrimoh, D. A., Kaloiani, I., Bandeira, I. D., Hunegnaw, S., Lan, L., Gholmieh, M., Buch, V., Williams, N. R. 2023; 5: 1146806


    The landscape of psychiatry is ever evolving and has recently begun to be influenced more heavily by new technologies. One novel technology which may have particular application to psychiatry is the metaverse, a three-dimensional digital social platform accessed via augmented, virtual, and mixed reality (AR/VR/MR). The metaverse allows the interaction of users in a virtual world which can be measured and manipulated, posing at once exciting new possibilities and significant potential challenges and risks. While the final form of the nascent metaverse is not yet clear, the immersive simulation and holographic mixed reality-based worlds made possible by the metaverse have the potential to redefine neuropsychiatric care for both patients and their providers. While a number of applications for this technology can be envisioned, this article will focus on leveraging the metaverse in three specific domains: medical education, brain stimulation, and biofeedback. Within medical education, the metaverse could allow for more precise feedback to students performing patient interviews as well as the ability to more easily disseminate highly specialized technical skills, such as those used in advanced neurostimulation paradigms. Examples of potential applications in brain stimulation and biofeedback range from using AR to improve precision targeting of non-invasive neuromodulation modalities to more innovative practices, such as using physiological and behavioral measures derived from interactions in VR environments to directly inform and personalize treatment parameters for patients. Along with promising future applications, we also discuss ethical implications and data security concerns that arise when considering the introduction of the metaverse and related AR/VR technologies to psychiatric research and care.

    View details for DOI 10.3389/fdgth.2023.1146806

    View details for PubMedID 37035477

    View details for PubMedCentralID PMC10080019

  • Psychopathological symptoms in parents and siblings of people on the autism spectrum: A systematic review and meta-analysis. Psychiatry research Bispo-Torres, A. C., Lucena, R., Tavares-Rodrigues, I. C., Barouh, J. L., Lins-Silva, D. H., Dorea-Bandeira, I., Souza, L. S., Faria-Guimarães, D., Tolentino, A., Miranda-Scippa, Â., Hermens, D. F., Sampaio, A. S., Quarantini, L. C., Glozier, N., Hickie, I. B., Bandeira, I. D. 2023; 323: 115145


    Parents and siblings of children on the autism spectrum experience significant distress, and for this reason, it is essential to understand the most prevalent psychopathological symptoms among this population. This work aims to establish the prevalence of psychopathological symptoms in parents and siblings of individuals on the autism spectrum, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) criteria. Searches were carried out using the PubMed/Medline, Embase, PsycINFO, SciELO, and Biblioteca Virtual em Saúde (BVS) databases. Twenty-three articles were included in this review. Depressive symptoms were the most frequently reported conditions, with a higher prevalence in mothers of children on the autism spectrum. In the meta-analysis, mothers of children on the autism spectrum scored higher by 0.42 standard deviations on the symptom scales (SMD 0.42; CI 0.25-0.59), with low statistical heterogeneity (I2 0%, p = 0.5) when compared with mothers of children with atypical development. The psychopathological symptoms of relatives should be investigated as part of the follow-up procedures for the child on the autism spectrum to facilitate their treatment.

    View details for DOI 10.1016/j.psychres.2023.115145

    View details for PubMedID 36921507

  • Arketamine as adjunctive therapy for treatment-resistant depression: A placebo-controlled pilot study. Journal of affective disorders Leal, G. C., Souza-Marques, B., Mello, R. P., Bandeira, I. D., Caliman-Fontes, A. T., Carneiro, B. A., Faria-Guimarães, D., Guerreiro-Costa, L. N., Jesus-Nunes, A. P., Silva, S. S., Lins-Silva, D. H., Fontes, M. A., Alves-Pereira, R., Cordeiro, V., Rugieri-Pacheco, S., Santos-Lima, C., Correia-Melo, F. S., Vieira, F., Sanacora, G., Lacerda, A. L., Quarantini, L. C. 2023


    Racemic ketamine is a mixture of (R)-ketamine (arketamine) and (S)-ketamine (esketamine), with the latter regarded as the main isomer for antidepressant effects. However, preclinical data and one open-label human trial suggest arketamine might exert a more potent and longer-lasting antidepressant effect with fewer side effects. We aimed to explore the feasibility of a randomized controlled trial of arketamine for treatment-resistant depression (TRD) and to assess its efficacy and safety compared to placebo.This is a, randomized, double-blind, crossover, pilot trial (n = 10). All participants received saline and arketamine (0.5 mg/kg) with a one-week interval. Treatment effects were analyzed with a linear mixed effects (LME) model.Our analysis suggested the presence of a carryover effect, so the main efficacy analysis was limited to the first week, which demonstrated a main effect of time (p = 0.038) but not for treatment (p = 0.40) or their interaction (p = 0.95). This indicates that depression improved over time, but without significant difference between arketamine and placebo. Analyzing the two weeks together, findings were the same. Dissociation and other adverse events were minimal.This was a pilot study with a small sample and underpowered.Arketamine was not superior to placebo for TRD but demonstrated to be extremely safe. Our findings reinforce the importance of continuing studies with this drug, with better powered clinical trials, perhaps considering a parallel design with higher or flexible doses and repeated administrations.

    View details for DOI 10.1016/j.jad.2023.02.151

    View details for PubMedID 36871913

  • Hikikomori Syndrome and Digital Technologies: A Systematic Review. Harvard review of psychiatry Sales-Filho, G. S., Bandeira, I. D., Argollo, N., Lucena, R. 2023; 31 (2): 50-59


    ABSTRACT: Hikikomori syndrome (HS) is a voluntary prolonged social isolation associated with personal and community impact. Previous evidence pointed out a possible relationship between this syndrome with addiction to digital technologies. Here we aim to understand the relationship between HS and digital technology use, overuse, and addictive behaviors, as well as potential therapeutic approaches.We conducted a systematic review of observational and intervention studies available in PubMed/MEDLINE, LILACS, IBECS, Embase, PsycINFO, and SciELO databases, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA 2020) criteria. The risk of bias was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consensus-based Clinical Case Reporting Guideline Development (CARE). Eligibility criteria were pre-, at-risk populations, or those with HS diagnosis, and any kind of technological overuse. Seventeen studies were included in the review, of which eight were cross-sectional, eight were case reports, and one was quasi-experimental. Hikikomori syndrome was associated with addition to digital technologies; no cultural differences were found. Environmental factors, such as a history of bullying, low self-esteem, and grief were identified as precursors of addictive behaviors. The included articles addressed addiction to digital technologies, electronic games, and social networks, among others, in HS. HS is cross-culturally associated with such addiction. The management of these patients remains challenging, and no target evidence-based treatments have been developed. The studies included in this review had several limitations, and more studies with a higher level of evidence are needed to support the results.

    View details for DOI 10.1097/HRP.0000000000000362

    View details for PubMedID 36884037

  • Efficacy and safety of transcranial direct current stimulation over the left dorsolateral prefrontal cortex in children and adolescents with attention-deficit/hyperactivity disorder: a randomized, triple-blinded, sham-controlled, crossover trial. Frontiers in psychiatry Guimarães, R. S., Bandeira, I. D., Barretto, B. L., Wanke, T., Alves, C. O., Barretto, T. L., de Carvalho, C. F., Dorea-Bandeira, I., Tolentino, A., Lins-Silva, D. H., Lucena, P. H., Lucena, R. 2023; 14: 1217407


    Although pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) has demonstrated efficacy, several individuals persist in experiencing social and academic impairment. Additionally, the occurrence of significant side effects may render the use of psychotropic medications untenable. However, Transcranial Direct Current Stimulation (tDCS), a non-invasive brain stimulation technique, shows promising results in treating ADHD.To investigate the efficacy and safety of tDCS on the performance of children and adolescents with ADHD in neuropsychological tests involving visual attention, visual and verbal working memory, and inhibitory control.This study was a triple-blind, randomized, sham-controlled, crossover clinical trial. The intervention consisted of a daily session of tDCS (2 mA) or sham targeting the left dorsolateral prefrontal cortex (L-DLPFC), for 30 min, on five consecutive days. The primary outcome was change in the Visual Attention Test, Fourth Edition (TAVIS-4) before and after each intervention. Subjects were also evaluated pre and post-tDCS using the Digit Span subtest of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Inhibiting Response (IR) subtest, and the Corsi Block-Tapping Task.Fifteen individuals were included, and no statistically significant difference was observed when comparing the results of the TAVIS-4, the IR of NEPSY-II, and the intragroup Digit Span subtest of WISC-V undertaken before and after the procedure. Adverse events were mainly self-limiting and transient. The participants did not perceive any benefit from tDCS when measured on the Patient Global Impression of Improvement (PGI-I) Scale.This study did not meet its primary endpoint and found no performance enhancement in any investigated neuropsychological outcomes relating to the intervention group.

    View details for DOI 10.3389/fpsyt.2023.1217407

    View details for PubMedID 38268562

    View details for PubMedCentralID PMC10806216

  • Social support among individuals with bipolar disorder during euthymic phase: a systematic review. Clinical psychology & psychotherapy Studart-Botto, P., Leda-Rego, G., Abbade, P., Bandeira, I. D., Miranda-Scippa, A. 2022


    INTRODUCTION: In spite of the recent increase in scientific publications showing an expressive interest in studies about social support, there are still scarce publications regarding this thematic and bipolar disorder, mostly when evaluating the individuals in the state of euthymia. Euthymia referred a state that a bipolar patient does not have signs/symptoms of (hipo)mania or depression, thus, assessing individuals in this state may reduce response bias.OBJECTIVE: Identify the impact of social support on bipolar disorder in patients in the euthymic phase.METHODS: A systematic search of observational studies on PubMed/Medline, PsycINFO, EMBASE, Scopus, and Web of Science databases, was performed from February 2021 to August 2022.RESULTS: In total, seven studies fulfilled the eligibility criteria. According to three studies, bipolar disorder patients had lower social support than healthy controls. Contrastingly, one study showed bipolar patients did not have different social support compared to healthy controls.CONCLUSIONS: Even though few papers with low or middle risk of bias were included in this review, we found that not only does social support could act as a protective factor for bipolar patients, but also that clinical manifestations of the disorder seem to affect social support. This systematic review suggests the narrowed evidence field with different measures and type of evaluation from studies on social support and bipolar disorder, which highlights the need for further investigations on this theme.

    View details for DOI 10.1002/cpp.2805

    View details for PubMedID 36443031

  • Autonomy, procedural and substantive: a discussion of the ethics of cognitive enhancement. Medicine, health care, and philosophy Bandeira, I. D., Lenine, E. 2022


    As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual's reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one's reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement.

    View details for DOI 10.1007/s11019-022-10110-2

    View details for PubMedID 36260257

  • A Novel PACS1 Variant Associated With Schuurs-Hoeijmakers Syndrome Phenotype in an Indigenous Descendant in Brazil: A Case Report. Cureus Lucena, P. H., Nonaka, C., Armani-Franceschi, G., Carneiro, P., Sales, H., Lucena, M., Bandeira, I. D., Solano, B., Lucena, R. 2022; 14 (10): e30486


    Schuurs-Hoeijmakers syndrome, an autosomal dominant disorder associated with mutations in the PACS1 gene, was initially identified in two unrelated children of European descent from a cohort of individuals with intellectual disabilities. This gene alteration significantly reduced cranial cartilaginous structures, inducing craniofacial alterations predominantly in a dominant-negative fashion. In this paper, we report a novel variant of PACS1 associated with Schuurs-Hoeijmakers syndrome: a boy aged two years and nine months of indigenous descent presenting with motor stereotypies, atypical sensory searches, language delay, and low socio-interactional reciprocity. Whole exome sequencing confirmed the presence of a heterozygous missense mutation c.943C>T p. (Arg315Trp) in the PACS1 gene. The phenotypic profile identified was similar to the other cases of Schuurs-Hoeijmakers syndrome described in the literature. This report highlights the importance of considering the possibility of PACS1 gene alterations and a diagnosis of Schuurs-Hoeijmakers syndrome in patients presenting craniofacial alterations associated with autistic features, psychomotor and language development delay.

    View details for DOI 10.7759/cureus.30486

    View details for PubMedID 36415352

    View details for PubMedCentralID PMC9674399

  • Esketamine for Unipolar Major Depression With Psychotic Features: A Retrospective Chart Review and Comparison With Nonpsychotic Depression. Journal of clinical psychopharmacology Souza-Marques, B., Telles, M., Leal, G. C., Faria-Guimarães, D., Correia-Melo, F. S., Jesus-Nunes, A. P., Vieira, F., Souza, L., Lins-Silva, D., Mello, R. P., Guerreiro-Costa, L., Bandeira, I. D., Lacerda, A. L., Sampaio, A. S., Quarantini, L. C. 2022


    The aims of the study were to assess subanesthetic esketamine as an antidepressant for major depressive disorder with psychotic features (PMDD) and to compare posttreatment symptoms among those with PMDD to a sample of nonpsychotic depression (major depressive disorder [MDD]).This study is a retrospective chart review of patients with major depression and current psychotic symptoms, treated with a single parenteral 0.5-mg/kg dose of esketamine. Depression symptoms were assessed at baseline and 24-hour posttreatment with the Montgomery-Åsberg Depression Rating Scale. Individuals with PMDD were matched in a 1:2 ratio to nonpsychotic MDD patients from a randomized, noninferiority clinical trial of esketamine.A total of 15 individuals with PMDD were included, which had higher baseline depression scores (PMDD = 40.9, MDD = 33.6, P = 0.004). A statistically significant change in depressive symptoms was found for the PMDD sample (β = -16.20 [95% confidence interval, -23.30 to -9.10], P < 0.001), and no difference between PMDD and MDD groups was observed in the matched-sample analysis (β = -2.2 [95% confidence interval, -9.32 to 4.58], P = 0.537). Treatment-induced dissociative symptoms were present for both groups, self-contained to within 2 hours after treatment, and no exacerbation of psychotic symptoms was found in clinical assessments.Results suggest a single 0.5-mg/kg dose of esketamine may benefit individuals with PMDD, and the symptom reduction may be comparable with esketamine's effects for MDD. Furthermore, esketamine may induce an antidepressant response in those with PMDD without complication of psychotic symptoms. Future research with controlled designs is warranted.

    View details for DOI 10.1097/JCP.0000000000001571

    View details for PubMedID 35727083

  • Letter to the Editor: Antidepressant and Antisuicidal Effects of Esketamine in Adolescents with Major Depressive Disorder and Suicidal Ideation: A Case Series. Journal of child and adolescent psychopharmacology Faria-Guimaraes, D., Vieira, F., Souza-Marques, B., Silva, S. S., Bandeira, I. D., Souza, L. S., Alves-Pereira, R., Fontes, M., Mello, R. P., Leal, G. C., Cardoso, T. A., Kapczinski, F., Lacerda, A. L., Sampaio, A. S., Quarantini, L. C. 2022

    View details for DOI 10.1089/cap.2022.0013

    View details for PubMedID 35708566

  • Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review. Harvard review of psychiatry Bandeira, I. D., Lins-Silva, D. H., Cavenaghi, V. B., Dorea-Bandeira, I., Faria-Guimaraes, D., Barouh, J. L., Jesus-Nunes, A. P., Beanes, G., Souza, L. S., Leal, G. C., Sanacora, G., Miguel, E. C., Sampaio, A. S., Quarantini, L. C. 2022; 30 (2): 135-145


    INTRODUCTION: First-line treatment for obsessive-compulsive disorder (OCD) includes exposure and response prevention behavioral therapy and serotonin reuptake inhibitors, particularly in combination. New and more effective treatments are needed, give that recent studies suggest that glutamatergic neurotransmission contributes to the pathophysiology of the disorder. In these circumstances, ketamine, as a potent N-methyl-D-aspartate receptor antagonist and glutamate modulator, offers alternative possibilities for OCD treatment.METHODS: This systematic review aims to investigate the effects of ketamine in OCD, following the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). Searches were carried out using the PubMed/MEDLINE, Embase, and PsycINFO databases.RESULTS: Nine articles were included, of which three were randomized controlled trials, three case reports, two open-label trials, and one a retrospective chart review. Reported data have shown a potential for fast onset of action and good tolerability of ketamine for OCD, even though the principal studies used only single-session racemic ketamine treatments, administered intravenously, and the results have been erratic. In addition, none of the available evidence demonstrates whether racemic ketamine, S-ketamine, or R-ketamine has the best efficacy in controlling OCD symptoms, and only sparse evidence suggests that a combination of ketamine and psychotherapy could benefit patients with OCD.CONCLUSION: In order to advance clinical practice regarding the use of ketamine in treating OCD, future randomized, double-blind, placebo-controlled trials are required. These trials need to use larger samples to explore ketamine and its enantiomers, with different methods of administration, multiple sessions, and appropriate washout periods.

    View details for DOI 10.1097/HRP.0000000000000330

    View details for PubMedID 35267254

  • Metabolomics of Major Depressive Disorder: A Systematic Review of Clinical Studies. Cureus F Guerreiro Costa, L. N., Carneiro, B. A., Alves, G. S., Lins Silva, D. H., Faria Guimaraes, D., Souza, L. S., Bandeira, I. D., Beanes, G., Miranda Scippa, A., Quarantini, L. C. 2022; 14 (3): e23009


    Although the understanding of the pathophysiology of major depressive disorder (MDD) has advanced greatly, this has not been translated into improved outcomes. To date, no biomarkers have been identified for the diagnosis, prognosis, and therapeutic management of MDD. Thus, we aim to review the biomarkers that are differentially expressed in MDD. A systematic review was conducted in January 2022 in the PubMed/MEDLINE, Scopus, Embase, PsycINFO, and Gale Academic OneFile databases for clinical studies published from January 2001 onwardusing the following terms: "Depression" OR "Depressive disorder" AND "Metabolomic."Multiple metabolites were found at altered levels in MDD, demonstrating the involvement of cellular signaling metabolites, components of the cell membrane, neurotransmitters, inflammatory and immunological mediators, hormone activators and precursors, and sleep controllers. Kynurenine and acylcarnitine were identified as consistent with depression and response to treatment. The most consistent evidence found was regarding kynurenine and acylcarnitine. Although the data obtained allow us to identify how metabolic pathways are affected in MDD, there is still not enough evidence to propose changes to current diagnostic and therapeutic actions. Some limitations are the heterogeneity of studies on metabolites, methods for detection, analyzed body fluids, and treatments used. The experiments contemplated in the review identified increased or reduced levels of metabolites, but not necessarily increased or reduced the activity of the associated pathways. The information acquired through metabolomic analyses does not specify whether the changes identified in the metabolites are a cause or a consequence of the pathology.

    View details for DOI 10.7759/cureus.23009

    View details for PubMedID 35415046

  • Clinical predictors of depressive symptom remission and response after racemic ketamine and esketamine infusion in treatment-resistant depression. Human psychopharmacology Jesus-Nunes, A. P., Leal, G. C., Correia-Melo, F. S., Vieira, F., Mello, R. P., Caliman-Fontes, A. T., Echegaray, M. V., Marback, R. F., Guerreiro-Costa, L. N., Souza-Marques, B., Santos-Lima, C., Souza, L. S., Bandeira, I. D., Kapczinski, F., Lacerda, A. L., Quarantini, L. C. 2022: e2836


    BACKGROUND: Major depressive disorder (MDD) is a leading cause of disability worldwide and most people do not achieve symptom remission. Treatment-resistant depression (TRD) is characterized by the failure of at least one adequate trial of a major class of antidepressant, with adequate time and dosage. We aimed to identify clinical predictors of depressive symptom remission and response 24h and 7days after racemic ketamine and esketamine infusions.METHODS: A randomized, double-blind, active-controlled, non-inferiority trial using ketamine and esketamine in TRD. Individuals diagnosed with MDD according to Diagnostic and Statistical Manual of Mental Disorders version IV and fulfilling TRD criteria were recruited from March 2017 to June 2018. Participants received a single subanesthetic dose of ketamine (0.5mg/kg) or esketamine (0.25mg/kg) for 40min. Depressive symptoms were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and symptom remission was defined as a MADRS score ≤7 and response defined as ≥50% reduction in depressive symptom severity, 24h and 7days after the infusion. Clinical variables were selected based on previous clinical trials. Stepwise backward logistic regression was used, considering a confidence level of 95%.RESULTS: 61 subjects were included: 39 (63.9%) were females with a mean age of 47.2±14.9. Higher number of therapeutic failures (Odds Ratio (OR)=0.677; 95% confidence interval (CI): 0.47-0.97) and higher severity of illness (OR=0.912; 95% CI: 0.83-0.99) were associated with fewer remissions of depressive symptoms 7days after intervention, and with fewer response in 24h (OR=0.583; 95% CI: 0,40; 0,84 and OR=0.909; 95% CI: 0,83; 0,99, respectively).CONCLUSION: Number of treatment failures and severity of illness were predictors of fewer remissions and responses of depressive symptoms in this TRD population. Study of predictors of remission may contribute to better selection patients that may benefit from receiving ketamine.

    View details for DOI 10.1002/hup.2836

    View details for PubMedID 35179810

  • Antidepressant and antisuicidal effects of esketamine in adolescents with major depressive disorder and suicidal ideation: a retrospective chart review Faria-Guimaraes, D., Souza, L. S., Souza-Marques, B., Vieira, F., Bandeira, I. D., Silva, S. S., Sampaio, A. S., Quarantini, L. C. ELSEVIER. 2021: S167-S168
  • Intravenous (R)-ketamine for bipolar depression: report of two cases Bandeira, I. D., Leal, G. C., Correia-Melo, F. S., Souza-Marques, B., Carneiro, B., Beanes, G., Lins-Silva, D. H., Dorea-Bandeira, I., Lacerda, A. T., Quarantini, L. C. ELSEVIER. 2021: S519-S520
  • Pilot study of the neurocognitive effects of arketamine in treatment-resistant depression and bipolar depression Souza-Marques, B., Santos-Lima, C., Vieira, F., Bandeira, I. D., Leal, G. C., Silva, S. S., Mello, R. P., Carneiro, B. A., Jesus-Nunes, A. P., Caliman-Fontes, A. T., Beanes, G., Lacerda, A. T., Sampaio, A. S., Quarantini, L. C. ELSEVIER. 2021: S660-S661
  • Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial. Trends in psychiatry and psychotherapy Caliman-Fontes, A. T., Leal, G. C., Correia-Melo, F. S., Paixao, C. S., Carvalho, M. S., Jesus-Nunes, A. P., Vieira, F., Magnavita, G., Bandeira, I. D., Mello, R. P., Beanes, G., Silva, S. S., Echegaray, M., Carvalho, L. P., Machado, P., Sampaio, A. S., Cardoso, T. d., Kapczinski, F., Lacerda, A. L., Quarantini, L. C. 1800


    OBJECTIVES: Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD).METHODS: Participants (n=53) are from a randomized, double-blinded clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n=27) and esketamine (0.25mg/kg, n=26) in TRD. Depression severity was assessed before, 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Asberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards.RESULTS: There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms.CONCLUSION: There was no significant treatment impact - neither with ketamine nor esketamine - in BDNF serum levels, despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

    View details for DOI 10.47626/2237-6089-2021-0298

    View details for PubMedID 34904800

  • Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study DEVELOPMENTAL NEUROREHABILITATION Armani-Franceschi, G., Luz, C., Lucena, P. H., d'Afonseca, D., Sales, H., Carvalho, A. L., Siqueira, I. C., Silva, K., Portuense, S., Monteiro, L., Bandeira, I. D., Melo, A., Lucena, R. 2021: 1-8


    Investigate the effect of botulinum toxin type-A (BoNT-A) on spasticity and motor performance in children with Cerebral Palsy (CP) related to Congenital Zika Syndrome (CZS).Prospective longitudinal observational study of 34 children with CP referred for BoNT-A treatment. Outcomes were evaluated with a muscle tone assessment scale (Modified Ashworth Scale - MAS) and the Patients' Global Impression of Improvement (PGI-I) scale.Mean age was 32.06 ± 3.07 months and 85% were classified as Gross Motor Function Classification System (GMFCS) V. Primitive reflexes were present in 56% of the sample. The majority of the parents (97.9%) reported improvement in range of motion or reduction in spasticity after treatment with botulinum toxin. No side effects were recorded. When compared to the baseline, median reduction in the MAS was 0.5 (IQR = 0).The findings of this study suggest that BoNT-A may effectively promote functional improvements and reduce muscle tone, improving the child's and family's quality of life.

    View details for DOI 10.1080/17518423.2021.1960917

    View details for Web of Science ID 000684739200001

    View details for PubMedID 34387523

  • Analysis of the superior temporal gyrus as a possible biomarker in schizophrenia using voxel-based morphometry of the brain magnetic resonance imaging: a comprehensive review CNS SPECTRUMS Bandeira, I. D., Barouh, J. L., Bandeira, I. D., Quarantini, L. 2021; 26 (4): 319-325


    The lack of predictive biomarkers for therapeutic responses to schizophrenia leads clinical procedures to be decided without taking into account the subjects' neuroanatomical features, a consideration, which could help in identifying specific pharmacological treatments for the remission of symptoms. Magnetic resonance imaging (MRI) is a technique widely used for radiological diagnosis and produces 3-dimensional images in excellent anatomical detail, and with a great capacity to differentiate soft tissue. Various MRI techniques of the human brain have emerged as a result of research, enabling structural tests that may help to in consolidate previous findings and lead to the discovery of new patterns of abnormality in schizophrenia. A literature review was undertaken to assess the superior temporal gyrus (STG) as a possible biomarker in schizophrenia with the use of voxel-based morphometry of the brain using MRI. Many findings in studies of schizophrenia using MRI have been inconclusive and, in some cases, conflicting, although interesting results have been obtained when attempting to correlate neuroimaging changes with aspects of clinical features and prognosis of the disease. The individuals affected by this mental illness appear to have smaller STG volumes when compared to healthy controls and also to subjects with a diagnosis of first-episode affective psychosis or groups of individuals at high risk of psychosis. However, the wide variety of definitions surrounding the STG found in a number of studies is a contributing factor to the lack of correlation between brain abnormalities and clinical symptoms. For instance, disagreements have arisen due to studies using regions of interest to analyze the STG whereas other studies prioritize the analysis of only STG subregions or specific supratemporal plane regions. It is necessary to standardize the nomenclature of the areas to be studied in the future, as this will enable more consistent results, allowing higher clinical and morphological correlations.

    View details for DOI 10.1017/S1092852919001810

    View details for Web of Science ID 000679801600009

    View details for PubMedID 31918770

  • Trait dissociation as a predictor of induced dissociation by ketamine or esketamine in treatment-resistant depression: Secondary analysis from a randomized controlled trial* JOURNAL OF PSYCHIATRIC RESEARCH Mello, R. P., Echegaray, M. F., Jesus-Nunes, A., Leaf, G. C., Magnavita, G. M., Vieira, F., Caliman-Fontes, A., Telles, M., Guerreiro-Costa, L. F., Souza-Marques, B., Bandeira, I. D., Santos-Lima, C., Marback, R. F., Correia-Melo, F. S., Lacerda, A. T., Quarantini, L. C. 2021; 138: 576-583


    Dissociative symptoms are common, possibly severe, side effects associated with the use of ketamine and esketamine in depression. We investigated the relationship between trait dissociation and dissociation induced by ketamine and esketamine used as augmentation therapy in treatment-resistant depression (TRD). Adults with TRD were randomly assigned to receive a single intravenous infusion, with a duration of 40 min, of either esketamine 0.25 mg/kg or ketamine 0.5 mg/kg. We assessed trait dissociation with the Dissociative Experience Scale (DES) and, to evaluate induced dissociation, the Clinician-Administered Dissociative States Scale (CADSS) was used. Thirty-two subjects received esketamine and 29 received ketamine. The groups had similar median DES scores (p = 0.26). More than 30% of the patients in both groups had DES scores ≥30 points. The median CADSS score in the esketamine group was equivalent to that in the ketamine group (p = 0.40). Every 5 points increment in the DES was associated with a 10.9% (95% CI 4.5-17.8%) increase in the CADSS, in an exponential fashion when the two groups were pooled together. Subjects with high trait dissociation had a higher risk of induced dissociation state (relative risk [RR] 1.41, 95% CI 1.11-1.78) and very high induced dissociation (RR 3.05, 95% CI 1.14-8.15). Induced dissociation was not a serious adverse effect. The findings suggest that trait dissociation is a predictor of induced dissociation by Ketamine or Esketamine in TRD subjects. Screening for trait dissociation and counseling patients with high trait dissociation on the risks of dissociation by these drugs are recommended.

    View details for DOI 10.1016/j.jpsychires.2021.05.014

    View details for Web of Science ID 000658540400013

    View details for PubMedID 33991996

  • The effects of transcranial direct current stimulation on attention and inhibitory control of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) Study protocol for a randomized, sham-controlled, triple-blind, cross-over trial MEDICINE Quadros Guimaraes, R., Bandeira, I. D., Barretto, B., Barretto, T., Wanke, T., Carvalho Alves, C., de Carvalho, C., Lucena, P. H., Rodrigues-Silva, L., Lucena, R. 2021; 100 (8): e24283


    Attention-deficit/hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and hyperactivity/impulsivity. Despite the proven efficacy of pharmacological treatment, many individuals continue to suffer socially and academically and some experience significant side effects that negate the use psychotropic drugs. Transcranial direct current stimulation (tDCS) is a cortical neuromodulation feature that has shown positive results in the treatment of various neuropsychiatric conditions.To investigate the effect of tDCS on the performance of children and adolescents with ADHD in the neuropsychological tests of visual attention, verbal, and inhibitory control.Triple blind, randomized, sham-controlled, cross-over trial involving tDCS in children and adolescents with ADHD. Initial screening will be performed using Swanson, Nolan, and Pelham - IVand Wechsler intelligence scale for children fourth edition vocabulary and cube subtests. Individuals will be evaluated pre-tDCS and post-tDCS with the Wechsler intelligence scale for children fourth edition Digitus subtest, neuropsychological assessment battery second edition inhibiting responses subtest, Corsi cubes, and visual attention test-4.

    View details for DOI 10.1097/MD.0000000000024283

    View details for Web of Science ID 000658985900010

    View details for PubMedID 33663047

    View details for PubMedCentralID PMC7909171

  • Ketamine and Esketamine augmentation for suicidal ideation: A randomized, double-blinded clinical trial GENERAL HOSPITAL PSYCHIATRY Vieira, F., Correia-Melo, F. S., Santos-Lima, C., Souza-Marques, B., Leal, G. C., Jesus-Nunes, A., Mello, R. P., Caliman-Fontes, A., Bandeira, I. D., Marback, R. F., Telles, M., Argolo, F. C., Lins-Silva, D. H., Echegaray, M. F., Beanes, G., Araujo-de-Freitas, L., Silva, S. S., Cardoso, T. A., Kapczinski, F., Turecki, G., Lacerda, A. T., Quarantini, L. C. 2021; 68: 97-99
  • Prevalence and factors associated with depression and anxiety in people living with HTLV-1: A systematic review with meta-analysis and meta-regression. General hospital psychiatry Souza, L. S., Lins-Silva, D. H., Dorea-Bandeira, I., Barouh, J. L., Tolentino, A., Bandeira, I. D., Quarantini, L. C. 2021; 73: 54-63


    Human T-cell lymphotropic virus type-1 (HTLV-1) infection is a neglected tropical disease associated with many clinical manifestations, such as erythematous-scaling skin lesions, cutaneous lymphomas, and spastic paraparesis, which could be a potential cause of mental health concerns. This study investigates the prevalence of symptoms and diagnoses of depression and anxiety and its associated factors in people living with HTLV-1 (PLWH).A systematic review was performed in the Pubmed/MEDLINE, Embase, LILACS, and PsycINFO databases for original studies investigating symptoms of depression and anxiety and diagnoses of major depressive disorder and anxiety disorders in PLWH, and a random-effects meta-analysis with meta-regression was performed to obtain a summary frequency of symptoms and diagnoses of depression and anxiety.Considering both symptoms and diagnoses, the pooled prevalence for depression was 35% (95% CI: 27 to 43) and for anxiety was 33% (95% CI: 23 to 45). Clinically significant symptoms were more prevalent than diagnosed disorders for depression (47% vs. 21%) and anxiety (44% vs. 11%). PLWH were more likely than seronegative controls to present symptoms and diagnoses of depression (pooled OR: 4.25; 95% CI: 2.7 to 6.68) and anxiety (pooled OR: 3.79; 95% CI: 2.6 to 5.52). Spastic paraparesis was significantly associated with symptoms and diagnoses of depression (pooled OR: 1.81; 95% CI: 1.11 to 2.95) and anxiety (pooled OR: 2.75; 95% CI 1.26 to 5.96).PLWH present a much higher prevalence of symptoms and diagnoses of depression and anxiety than seronegative controls, which could be explained by social vulnerability or neurological impairment associated with spastic paraparesis. More studies comparing asymptomatic PLWH and seronegative controls are needed.

    View details for DOI 10.1016/j.genhosppsych.2021.08.012

    View details for PubMedID 34600354

  • Neuroplasticity and non-invasive brain stimulation in the developing brain. Progress in brain research Bandeira, I. D., Lins-Silva, D. H., Barouh, J. L., Faria-Guimarães, D., Dorea-Bandeira, I., Souza, L. S., Alves, G. S., Brunoni, A. R., Nitsche, M., Fregni, F., Lucena, R. 2021; 264: 57-89


    The brain is a dynamic organ whose growth and organization varies according to each subject's life experiences. Through adaptations in gene expression and the release of neurotrophins and neurotransmitters, these experiences induce a process of cellular realignment and neural network reorganization, which consolidate what is called neuroplasticity. However, despite the brain's resilience and dynamism, neuroplasticity is maximized during the first years of life, when the developing brain is more sensitive to structural reorganization and the repair of damaged neurons. This review presents an overview of non-invasive brain stimulation (NIBS) techniques that have increasingly been a focus for experimental research and the development of therapeutic methods involving neuroplasticity, especially Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). Due to its safety risk profile and extensive tolerability, several trials have demonstrated the benefits of NIBS as a feasible experimental alternative for the treatment of brain and mind disorders in children and adolescents. However, little is known about the late impact of neuroplasticity-inducing tools on the developing brain, and there are concerns about aberrant plasticity. There are also ethical considerations when performing interventions in the pediatric population. This article will therefore review these aspects and also obstacles related to the premature application of NIBS, given the limited evidence available concerning the extent to which these methods interfere with the developing brain.

    View details for DOI 10.1016/bs.pbr.2021.04.003

    View details for PubMedID 34167665

  • Suicidal behavior in individuals with amyotrophic lateral sclerosis: A systematic review JOURNAL OF AFFECTIVE DISORDERS Silva-Moraes, M., Bispo-Torres, A., Barouh, J. L., Lucena, P. H., Armani-Franceschi, G., Dorea-Bandeira, I., Vieira, F., Miranda-Scippa, A., Quarantini, L. C., Lucena, R., Bandeira, I. D. 2020; 277: 688-696


    Amyotrophic Lateral Sclerosis (ALS) leads to a drastic reduction in quality of life, generating intense psychological distress and predisposing those affected to mental illness and, in more severe cases, suicidal behavior.This is a systematic review aiming to estimate the frequency of wish to die, suicide ideation and suicide in individuals with ALS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).The following databases were used: Pubmed/MEDLINE, PsycINFO, Embase, SciELO, Biblioteca Virtual de Saúde (BVS), and Cochrane Library. The choice of appropriate descriptors, or their equivalents, to define the search terms was based on the technical and scientific vocabulary of each database.13 articles were included in the present systematic review, of which three were cross-sectional studies, nine were cohort-type and there was one case-control study. The studies show that individuals with ALS have a higher risk of suicide in relation to the general population, and there is evidence that this risk is even higher in the early stages of the disease. Major Depressive Disorder was the most prevalent mental disorder in the studies included. This mental health concern is often undertreated, leading to the increased susceptibility of this population to suicide.In general, the study samples represent a highly heterogeneous population while many instruments used in the data collection were not uniform.The high degree of psychological vulnerability of this population, associated with a greater predisposition to suicidal behavior, should be minimized through public health measures.

    View details for DOI 10.1016/j.jad.2020.08.066

    View details for Web of Science ID 000577467600017

    View details for PubMedID 32911219

  • The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study NEUROLOGICAL RESEARCH Sales, H. F., Cerqueira, C., Vaz, D., Medeiros-Rios, D., Armani-Franceschi, G., Lucena, P. H., Sternberg, C., Nobrega, A. C., Luz, C., Fonseca, D., Carvalho, A. L., Monteiro, L., Siqueira, I. C., Bandeira, I. D., Lucena, R. 2021; 43 (1): 54-60


    The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS).This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents' subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders.Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre- and post-treatment reduction in drooling severity occurred (Z = -3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII.This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.

    View details for DOI 10.1080/01616412.2020.1820698

    View details for Web of Science ID 000568935800001

    View details for PubMedID 32915712

  • NMDA Antagonists and Their Role in the Management of Bipolar Disorder: a Review CURRENT BEHAVIORAL NEUROSCIENCE REPORTS Delfino, R. S., Surjan, J., Bandeira, I. D., Braziliano, L., Correia-Melo, F. S., Del-Porto, J. A., Quarantini, L. C., Lacerda, A. T. 2020; 7 (2): 76-85
  • Efficacy and safety of adjunctive therapy using esketamine or racemic ketamine for adult treatment-resistant depression: A randomized, double-blind, non-inferiority study JOURNAL OF AFFECTIVE DISORDERS Correia-Melo, F. S., Leal, G. C., Vieira, F., Jesus-Nunes, A., Mello, R. P., Magnavita, G., Caliman-Fontes, A., Echegaray, M. F., Bandeira, I. D., Silva, S. S., Cavalcanti, D. E., Araujo-de-Freitas, L., Sarin, L. M., Tuena, M. A., Nakahira, C., Sampaio, A. S., Del-Porto, J. A., Turecki, G., Loo, C., Lacerda, A. T., Quarantini, L. C. 2020; 264: 527-534


    Ketamine and its enantiomers have recently been highlighted as one of the most effective therapeutic options in refractory depression. However, racemic ketamine and esketamine have not been directly compared. The aim of this study is to assess the efficacy and safety of esketamine compared to ketamine in patients with treatment-resistant depression (TRD).This is a randomized, double-blind, active-controlled, bicentre, non-inferiority clinical trial, with two parallel groups. Participants were randomly assigned to a 40-min single intravenous infusion of ketamine 0.5 mg/kg or esketamine 0.25 mg/kg. The primary outcome was the difference in remission rates for depression 24 h following intervention using the Montgomery-Åsberg Depression Rating Scale (MADRS), with a non-inferiority margin of 20%.63 subjects were included and randomly assigned (29 to receive ketamine and 34 to receive esketamine). At 24 h, 24.1% of participants in the ketamine group and 29.4% of participants in the esketamine group showed remission, with a difference of 5.3% (95% CILB -13.6%), confirming non-inferiority. MADRS scores improved from 33 (SD 9.3) to 16.2 (SD 10.7) in the ketamine group and from 33 (SD 5.3) to 17.5 (SD 12.2) in the esketamine one, with a difference of -5.27% (95% CILB, -13.6). Both groups presented similar mild side effects.Esketamine was non-inferior to ketamine for TRD 24 h following infusion. Both treatments were effective, safe, and well tolerated.Registered in Japan Primary Registries Network: UMIN000032355.

    View details for DOI 10.1016/j.jad.2019.11.086

    View details for Web of Science ID 000510380300069

    View details for PubMedID 31786030

  • Intravenous arketamine for treatment-resistant depression: open-label pilot study EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE Leal, G. C., Bandeira, I. D., Correia-Melo, F. S., Telles, M., Mello, R. P., Vieira, F., Lima, C. S., Jesus-Nunes, A., Guerreiro-Costa, L. F., Marback, R. F., Caliman-Fontes, A., Marques, B. S., Bezerra, M. O., Dias-Neto, A. L., Silva, S. S., Sampaio, A. S., Sanacora, G., Turecki, G., Loo, C., Lacerda, A. T., Quarantini, L. C. 2021; 271 (3): 577-582


    We aimed to analyze the efficacy and safety of arketamine, the R(-)-enantiomer of ketamine, for treatment-resistant depression (TRD) in humans. Open-label pilot trial, seven subjects with TRD received a single intravenous infusion of arketamine (0.5 mg/kg); primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) 24 h after. Mean MADRS dropped from 30.7 before infusion to 10.4 after one day, a mean difference of 20.3 points [CI 95% 13.6-27.0; p < 0.001]; dissociation was nearly absent. Arketamine might produce fast-onset and sustained antidepressant effects in humans with favorable safety profile, like previously reported with animals; further controlled-trials are needed.

    View details for DOI 10.1007/s00406-020-01110-5

    View details for Web of Science ID 000516283100001

    View details for PubMedID 32078034

  • KPTN gene homozygous variant-related syndrome in the northeast of Brazil: A case report AMERICAN JOURNAL OF MEDICAL GENETICS PART A Lucena, P. H., Armani-Franceschi, G., Bispo-Torres, A., Bandeira, I. D., Lucena, M. G., Maldonado, I., Veiga, M. F., Miguel, D., Lucena, R. 2020; 182 (4): 762-767


    Alteration of the KPTN gene, responsible for the coding of kaptin (a protein involved in actin cytoskeletal dynamics), causes a syndrome characterized by macrocephaly, neurodevelopmental delay and epileptic seizures. We report the first Brazilian case of KPTN gene variation, previously described in nine subjects from four interlinked families from an Amish community in Ohio, two Estonian siblings and a 9-year-old boy from Kansas City. We report a case of KPTN-related syndrome in a 5-year-old child which presented macrocephaly, muscular hypotonia, and global development delay. The neurological examination revealed below-expected performance in coordination and balance tests, dyspraxia, and hand-mouth synkinesia. Expressive language was characterized by phono-articulatory imprecision, abundance of phonological processes and morphosyntactic immaturity. Neuropsychological assessment revealed intellectual disability with impairment of verbal and executive functions. Exome sequencing was performed. Analysis revealed a homozygous 2-nucleotide duplication c.597_598dup p.(Ser200Ilefs*55) in the KPTN gene, which is predicted to lead to a translational frameshift and formation of a premature stop codon. The phenotypic profile is similar to the cases described in the other families. Presence of macrocephaly and delayed development indicate the possibility of KPTN gene variation. Genetic testing should be carried out at an early stage in order to reach a timely diagnosis.

    View details for DOI 10.1002/ajmg.a.61492

    View details for Web of Science ID 000510119500001

    View details for PubMedID 31999056

  • Transcranial-direct current stimulation on attention and inhibitory control of children and adolescents with ADHD: A randomized, crossover, triple-blind, sham-controlled study Guimaraes, R. Q., Bandeira, I. D., Barretto, B. L., Barretto, T. L., Wanke, T., Alves, C. C., Carvalho, C. F., Lucena, P. H., Rodrigues-Silva, L., Lucena, R. ELSEVIER. 2019: S551-S552
  • Dissociative symptoms predict antidepressant response after infusion of ketamine in treatment-resistant depression Echegaray, M. F., Mello, R., Correia-Melo, F. S., Leal, G. C., Jesus-Nunes, A. P., Vieira, F., Fontes, A. C., Beanes, G., Magnavita, G., Bandeira, I. D., Lacerda, A. T., Quarantini, L. C. ELSEVIER. 2019: S321-S322
  • Acute antidepressant effects of different ketamine isomers in rats submitted to maternal separation animal model: A pilot study Beanes, G., Carneiro, B., Marques, G., Bandeira, I. D., Reus, G. Z., Mello, R., Lacerda, A. T., Santana, R. C., Quarantini, L. C. ELSEVIER. 2019: S324-S325
  • Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: a systematic review DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Barreto, T. M., Bento, M. N., Barreto, T. M., Jagersbacher, J., Jones, N. S., Lucena, R., Bandeira, I. D. 2020; 62 (2): 163-+


    To estimate the prevalence of mental illness in parents of children with cerebral palsy (CP).This is a systematic review that follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols in the search for observational studies determining the prevalence of depression, anxiety, and substance abuse in parents of individuals with CP. The information sources used for this study were: PubMed, SciELO, Cochrane Library, Clinical Trials, and Biblioteca Virtual de Saúde.Fourteen articles were selected and included, investigating 1264 mothers and 105 fathers of children with CP. Data extracted for analysis were divided into three categories: study data, data about participants with CP, and data about parents. All studies included volunteer parents, of whom 95 per cent were female.CP is related to a higher prevalence of symptoms of depression and anxiety in parents. Factors such as a child's degree of functionality and socioeconomic level may influence the frequency of mental disorders in parents. However, these studies have heterogeneous samples and applied different criteria to characterize their populations.Depression and anxiety are more prevalent for parents of children with cerebral palsy (CP) than parents of typically developing children. The child's illness severity is a risk factor for mental illness in parents of children with CP. The more time spent on child care, the higher the risk of mental illness among mothers of children with CP. There is a lack of reliable data in the literature on substance abuse in parents of children with CP.

    View details for DOI 10.1111/dmcn.14321

    View details for Web of Science ID 000478850100001

    View details for PubMedID 31381150

  • Transcranial direct current stimulation in the treatment of cerebellar ataxia: A two-phase, double-blind, auto-matched, pilot study CLINICAL NEUROLOGY AND NEUROSURGERY Barretto, T., Bandeira, I., Jagersbacher, J., Barretto, B., Souza de Oliveira e Torres, A., Pena, N., Vivas Miranda, J., Lucena, R. 2019; 182: 123-129


    To assess the impact of tDCS on posture, gait and coordination of movements in subjects with cerebellar ataxia.This is a two-phase, double blind, auto matched, pilot study. Seven people were selected to participate in the study aged from 14 to 57. tDCS and sham-tDCS were applied at different times to all participants for 40 min over five consecutive days so that they were blind to which of the two techniques was applied at any one time. The area stimulated was the bilateral motor cortex. Subjects were evaluated before and after the interventions using the Scale for Assessment and Rating of Ataxia (SARA) and specific tests to measure posture and balance were carried out using the Wii Fit platform and CvMob software.The study indicates a statistically significant improvement in respect of gait parameters and the total score of the SARA scale and Wii Fit platform after tDCS when compared with data obtained from sham-tDCS trials (p: 0,03). The adverse events relating to tDCS were all self-limiting and from mild to moderate intensity.Despite the small sample size, tDCS showed positive results in some motor parameters and could be considered a valuable new option for the treatment of cerebellar ataxias.

    View details for DOI 10.1016/j.clineuro.2019.05.009

    View details for Web of Science ID 000472812800024

    View details for PubMedID 31121471

  • Primary cutaneous nocardiosis JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT Bandeira, I., Guimaraes-Silva, P., Cedro-Filho, R., Pedreira de Almeida, V., Bittencourt, A. L., Brites, C. 2019; 17 (3): 327-329

    View details for DOI 10.1111/ddg.13770

    View details for Web of Science ID 000462613000010

    View details for PubMedID 30883034

  • Impact of Transcranial Direct Current Stimulation on Reading Skills of Children and Adolescents With Dyslexia. Child neurology open Rios, D. M., Correia Rios, M., Bandeira, I. D., Queiros Campbell, F., de Carvalho Vaz, D., Lucena, R. 2018; 5: 2329048X18798255


    Rehabilitation techniques have been used to facilitate reading acquisition in dyslexia. However, many individuals continue to present academic impairment throughout life. New intervention strategies are necessary to further help this population.Assess the impact of transcranial direct current stimulation on reading skills in children and adolescents with dyslexia.The study was conducted with one-group pretest-posttest. Participants received 2 mA transcranial direct current stimulation during 30 minutes for 5 consecutive days. Reading performance was measured by a group of tasks (identification and reading of letters, syllables, words, nonwords, and text).A significant increase in the number of correct answers for nonwords and text tasks was observed after transcranial direct current stimulation (P = .035 and P = .012, respectively).The transcranial direct current stimulation seems to be a promising tool for the treatment of reading problems in dyslexia. Future studies are necessary to confirm the effects of transcranial direct current stimulation and to establish optimal intervention protocol in this population.

    View details for DOI 10.1177/2329048X18798255

    View details for PubMedID 30306098

    View details for PubMedCentralID PMC6174647

  • Comparative study of esketamine and racemic ketamine in treatment-resistant depression Protocol for a non-inferiority clinical trial MEDICINE Correia-Melo, F. S., Leal, G. C., Carvalho, M. S., Jesus-Nunes, A., Ferreira, C. N., Vieira, F., Magnavita, G., Vale, L. S., Mello, R. P., Nakahira, C., Argolo, F. C., Cardoso, T., Souza, C. S., Fontes, A. C., Ferreira, M. B., Araujo-de-Freitas, L., Tuena, M. A., Echegaray, M. F., Cavalcanti, D. E., Lucchese, A. C., Bandeira, I. D., Telles, M., Lima, C. S., Sampaio, A. S., Silva, S. S., Marback, R. F., Del-Porto, J. A., Abreu, J., Sarin, L. M., Paixao, C. S., Carvalho, L. P., Machado, P. L., Turecki, G., Lacerda, A. T., Quarantini, L. C. 2018; 97 (38): e12414


    The use of ketamine as an option in the treatment of depressive disorder is growing rapidly, supported by numerous clinical trials attesting its efficacy and safety. Esketamine, the S (+) enantiomer of ketamine, is the most widely used form in the anesthetic environment in some countries, and new studies have shown that it may also be effective in depression and with better tolerability. However, no study so far has directly compared esketamine with racemic ketamine. Here we propose a protocol of a clinical trial to evaluate esketamine as a noninferior medication when compared to ketamine in the treatment of patients with treatment-resistant depression.This study protocol is for a randomized, controlled, double-blind noninferiority clinical trial. Subjects will be 18 years or older, with major depression characterized as treatment-resistant. Participants will receive a single infusion of either esketamine (0.25 mg/kg) or ketamine (0.5 mg/kg) over 40 minutes. The primary outcome will be the difference in remission rates between the 2 treatment arms at 24 and 72 hours after drug infusion. Secondary outcomes will include other timepoints, measurements of cognition, dissociation, and blood biomarkers.A head-to-head study is the best way to evaluate whether the esketamine is in fact comparable to the racemic ketamine in terms of both efficacy and safety, and, if positive, it would be an initial step to increase the access to that type of treatment worldwide.The study was approved by the local Institutional Review Board (University Hospital Professor Edgard Santos-Federal University of Bahia-Number: 46657415.0.0000.0049). Subjects will only participate after voluntarily agreeing and signing the Informed Consent Form. The study findings will be published in peer-reviewed journals and presented at national and international conferences.This trial has been registered in the Japan Primary Registries Network (JPRN): UMIN000032355, which is affiliated with the World Health Organization.

    View details for DOI 10.1097/MD.0000000000012414

    View details for Web of Science ID 000449338200064

    View details for PubMedID 30235716

    View details for PubMedCentralID PMC6160185

  • Medical education and leadership: a call to action for Brazil's mental health system INTERNATIONAL JOURNAL OF MEDICAL EDUCATION Bandeira, I. D., Mendoza, J. 2018; 9: 170-172

    View details for DOI 10.5116/ijme.5b1b.b0a2

    View details for Web of Science ID 000437707500001

    View details for PubMedID 29936494

    View details for PubMedCentralID PMC6129155

  • BOTULINUM TOXIN TYPE A IN THE TREATMENT OF FACIAL MYOTONIA IN SCHWARTZ-JAMPEL SYNDROME MUSCLE & NERVE Bandeira, I., Jagersbacher, J., Barretto, T., Santos, C., Lucena, R. 2017; 56 (2): E10-E11

    View details for DOI 10.1002/mus.25610

    View details for Web of Science ID 000406875000002

    View details for PubMedID 28187499

  • Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment REVISTA BRASILEIRA DE ANESTESIOLOGIA Kraychete, D., Sakata, R., Carvalho Lannes, L., Bandeira, I., Sadatsune, E. 2016; 66 (5): 505-512


    Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available.This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively.Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.

    View details for DOI 10.1016/j.bjane.2014.12.005

    View details for Web of Science ID 000385857400011

    View details for PubMedID 27591465

  • Congenital Chikungunya Virus Infection after an Outbreak in Salvador, Bahia, Brazil AJP REPORTS Ribeiro Lyra, P., Campos, G., Bandeira, I., Sardi, S., de Moura Costa, L., Santos, F., Santos Ribeiro, C., Barreto Jardim, A., Travassos Santiago, A., Ribeiro de Oliveira, P., Oliveira Moreira, L. 2016; 6 (3): E299-E300


    There is little information about the congenital chikungunya virus (CHIKV) transmission. We describe two cases of well-documented congenital CHIKV infection in Salvador-Brazil, where CHIKV has been identified since 2014. The outbreak in the city led to the clinical CHIKV diagnoses of both pregnant women 2 days before delivery. Urine and blood samples from the mothers and newborns were collected and tested for reverse transcription-polymerase chain reaction (PCR) analysis for Zika, dengue, and CHIKV. Both neonates and mothers had positive urine and serum PCR results for CHIKV. The newborns had significant perinatal complications and were admitted to the neonatal intensive care unit. The purpose of our case report is to show how severe congenital CHIKV infection can be and the importance to include CHIKV infection in the differential diagnosis of neonatal sepsis when mothers have clinical signs of the disease and live in an affected area.

    View details for DOI 10.1055/s-0036-1587323

    View details for Web of Science ID 000382531200008

    View details for PubMedID 27555980

    View details for PubMedCentralID PMC4993616

  • Transcranial Direct Current Stimulation in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD): A Pilot Study JOURNAL OF CHILD NEUROLOGY Bandeira, I., Quadros Guimaraes, R., Jagersbacher, J., Barretto, T., de Jesus-Silva, J., Santos, S., Argollo, N., Lucena, R. 2016; 31 (7): 918-924


    Studies investigating the possible benefits of transcranial direct current stimulation on left dorsolateral prefrontal cortex in children and adolescents with attention-deficit hyperactivity disorder (ADHD) have not been performed. This study assesses the effect of transcranial direct current stimulation in children and adolescents with ADHD on neuropsychological tests of visual attention, visual and verbal working memory, and inhibitory control. An auto-matched clinical trial was performed involving transcranial direct current stimulation in children and adolescents with ADHD, using SNAP-IV and subtests Vocabulary and Cubes of the Wechsler Intelligence Scale for Children III (WISC-III). Subjects were assessed before and after transcranial direct current stimulation sessions with the Digit Span subtest of the WISC-III, inhibitory control subtest of the NEPSY-II, Corsi cubes, and the Visual Attention Test (TAVIS-3). There were 9 individuals with ADHD according to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. There was statistically significant difference in some aspects of TAVIS-3 tests and the inhibitory control subtest of NEPSY-II. Transcranial direct current stimulation can be related to a more efficient processing speed, improved detection of stimuli, and improved ability to switch between an ongoing activity and a new one.

    View details for DOI 10.1177/0883073816630083

    View details for Web of Science ID 000376264800017

    View details for PubMedID 26879095