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Deep Brain Stimulation for Major Depression—Steps on a Long and Winding Road

2015; Elsevier BV; Volume: 78; Issue: 4 Linguagem: Inglês

10.1016/j.biopsych.2015.06.020

1873-2402

Thomas E. Schläepfer,

Treatment of Major Depression

Most patients with psychiatric disorders respond to combinations of psychotherapy and psychopharmacotherapy; however, some patients experience little, if any, benefit even after many years of treatment ( 1 Schlaepfer T.E. Agren H. Monteleone P. Gasto C. Pitchot W. Rouillon F. et al. The hidden third: Improving outcome in treatment-resistant depression. J Psychopharmacol. 2012; 26: 587-602 Crossref PubMed Scopus (50) Google Scholar ). Over the past decade, different modalities of targeted neuromodulation—among them most prominently deep brain stimulation (DBS)—are being actively researched as putative approaches to very treatment-resistant forms of those disorders. The fact that patients included in all DBS studies so far had been treated unsuccessfully for many years with conventional treatment methods renders these findings remarkable. It is astonishing and unexpected that any intervention would have beneficial consequences in patients who did not respond to up to 60 treatment attempts with psychotherapy, medications, and electroconvulsive therapy ( 2 Schlaepfer T.E. Bewernick B.H. Kayser S. Hurlemann R. Coenen V.A. Deep brain stimulation of the human reward system for major depression—rationale, outcomes and outlook. Neuropsychopharmacology. 2014; 39: 1303-1314 Crossref PubMed Scopus (106) Google Scholar ). Specifically, DBS to Brodmann area 25 ( 3 Mayberg H.S. Lozano A.M. Voon V. McNeely H.E. Seminowicz D. Hamani C. et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005; 45: 651-660 Abstract Full Text Full Text PDF PubMed Scopus (2782) Google Scholar ), the anterior branch of the capsula interna ( 4 Malone Jr, D.A. Dougherty D.D. Rezai A.R. Carpenter L.L. Friehs G.M. Eskandar E.N. et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009; 65: 267-275 Abstract Full Text Full Text PDF PubMed Scopus (646) Google Scholar ), the nucleus accumbens ( 5 Schlaepfer T.E. Cohen M.X. Frick C. Kosel M. Brodesser D. Axmacher N. et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2008; 33: 368-377 Crossref PubMed Scopus (701) Google Scholar ), and the superior branch of the medial forebrain bundle ( 6 Schlaepfer T.E. Bewernick B.H. Kayser S. Madler B. Coenen V.A. Rapid effects of deep brain stimulation for treatment-resistant major depression. Biol Psychiatry. 2013; 73: 1204-1212 Abstract Full Text Full Text PDF PubMed Scopus (370) Google Scholar ) has been reported to be associated with antidepressant effects in these patients. None of the 22 studies published so far has been sham controlled ( 7 Morishita T. Fayad S.M. Higuchi M.A. Nestor K.A. Foote K.D. Deep brain stimulation for treatment-resistant depression: Systematic review of clinical outcomes. Neurotherapeutics. 2014; 11: 475-484 Crossref PubMed Scopus (153) Google Scholar ). A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Chronic Treatment-Resistant DepressionBiological PsychiatryVol. 78Issue 4PreviewMultiple open-label trials of deep brain stimulation (DBS) for treatment-resistant depression (TRD), including those targeting the ventral capsule/ventral striatum target, have shown encouraging response rates. However, no randomized controlled trials of DBS for TRD have been published. Full-Text PDF