Deep brain stimulation for treatment-resistant depression: a safe and effective option

ABSTRACT

Introduction: Major depressive disorder (MDD) is the leading cause of years lost to disability worldwide. Pharmacotherapy and psychotherapy are effective treatments in most depressive episodes; but, about 30% of MDD patients remain symptomatic, and relapse is a common event. Recently, deep brain stimulation (DBS) has emerged as a valid therapeutic option in treatment-resistant depression (TRD) patients.

Areas covered: In this paper, the authors summarize the findings of studies focused on these pathophysiologic phenomena and specifically on the role of DBS as a therapeutic option in TRD patients. The authors simply reviewed RCTs, open-label studies, neurophysiological mechanisms of DBS in MDD, and the possible role of different targets. Finally, we suggest possible future options.

Expert opinion: Depression is a systems-level disorder, involving several brain structures. Neuroimaging studies demonstrate multiple interconnected regions that modulate different neural networks. DBS can modulate different targets, and others are under investigation. Among these subcallosal cingulate gyrus (SCG), ventral capsule and ventral striatum (VC/VS) seems to be the most relevant targets. We believe that, in the next future, DBS for TRD might become a first-line of treatment, especially using directional leads, that may help us to improve therapeutic effects.

KEYWORDS:

• Deep brain stimulation
• treatment resistant depression
• ventral capsule
• ventral striatum
• Brodmann area 25
• subgenual cingulate
• nucleus accumbens

Article highlights

• DBS in MDD has been studied as a potential treatment for severe and refractory major depressive disorder since 2005.

• Identifying brain targets associated with long-term response is an important next step in MDD DBS research.

• Positive outcomes would seem to be dependent on pairing optimal procedural accuracy (anatomic targeting, stimulation parameter selection).

• Possible adverse effects of DBS can include intracranial bleeding, lead isolation, lead fracture, and infection.

• Further studies are necessary in order to conduct trials that will assess not only short-term efficacy but meaningful, sustained response over the long term.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.