Deep Brain Stimulation in Treatment Resistant Depression: A Systematic Review

Author(s): Rohit Aiyer , Russell T. Joffe .

Journal Name: Current Psychopharmacology

Volume 4 , Issue 1 , 2015

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Abstract:

Objective: To investigate clinical response rates of Deep Brain Stimulation (DBS) as an intervention for treatment resident depression (TRD).

Method: We performed a Pubmed search using the search terms deep brain stimulation, treatment resistant depression, DBS and TRD which resulted in three-hundred and seventythree records. Eighty-four articles were screened and duplicates were removed. Inclusion criteria were: 1.) Diagnosis of Major Depressive Disorder, 2.) Well documented TRD involving failure of prior established pharmacological treatments, 3.) Controlled trials, uncontrolled observational studies and case series, 4.) Intervention used was DBS and 5.) Measures of depressive symptomology pre and post treatment using a validated psychiatric scale to allow assessment of response. Exclusion criteria include: a reanalysis of pre-published data, review articles, single case reports, non-English studies and studies involving non-human animal models. Twelve articles were eligible, with 2 being excluded as they were case reports. Consequently, ten articles met criteria and were included in the systematic review.

Results: Overall, 10 studies were compiled and analyzed for this systematic review, with the number of participants in the study ranging from 4 to 30. 4 of the 6 studies showed 50% or more improvement in measures of clinical response in the subcallosal cingulate white matter /brodmann area 25 neuroanatomic regions. The ventral anterior internal capsule and ventral striatum sites of stimulation showed 71% and 23% clinical response rates in 2 studies. The nucleus accumbens elicited a 45% clinical response rate. Finally, the supero-lateral branch of the medial forebrain bundle (bilaterally) resulted in 86% clinical response rate in 1 study.

Conclusion: Given the morbidity and mortality associated with Major Depressive Disorder and the challenges of TRD, the studies to date strongly support further systematic investigation of the use of DBS in the treatment of refractory major depressive disorder.

Clinical Implications:

There is promising data to show that DBS is an effective intervention for TRD.

Further investigation is needed to assess DBS as an intervention, particularly with larger sample. sizes needed in future studies

Limitations:

The samples sizes reviewed in the studies are small.

The inclusion of open label research design.

Limited comparison across studies due to differences in patient selection, electrode placement and variable duration of treatment.

Keywords: DBS, depressive disorder, deep brain stimulation, Trd, treatment resistant depression, unipolar depression.

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Article Details

VOLUME: 4
ISSUE: 1
Year: 2015
Page: [10 - 16]
Pages: 7
DOI: 10.2174/2211556004666150918194517

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