Deep brain stimulation for depression: Scientific issues and future directions

Mosley, Philip E., Marsh, Rodney and Carter, Adrian (2015) Deep brain stimulation for depression: Scientific issues and future directions. Australian and New Zealand Journal of Psychiatry, 49 11: 967-978. doi:10.1177/0004867415599845


Author Mosley, Philip E.
Marsh, Rodney
Carter, Adrian
Title Deep brain stimulation for depression: Scientific issues and future directions
Journal name Australian and New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 1440-1614
0004-8674
Publication date 2015-11-01
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1177/0004867415599845
Open Access Status Not yet assessed
Volume 49
Issue 11
Start page 967
End page 978
Total pages 12
Place of publication London, United Kingdom
Publisher Sage Publications
Collection year 2016
Language eng
Formatted abstract
Objective: Deep brain stimulation is an experimental intervention for treatment-resistant depression. Open trials have shown a sustained response to chronic stimulation in many subjects. However, two recent randomised, double-blind, placebo-controlled trials failed to replicate these results. This article is a conceptual paper examining potential explanations for these discrepant findings.

Method: We conducted a systematic review of the published studies obtained from PubMed and PsycINFO. Studies were selected if they directly examined the impact of deep brain stimulation on depressive symptoms. We excluded case reports and papers re-describing the same cohort of patients. We compared them with data from the placebo-controlled trials, available from Clinicaltrials.gov and abstracts of the American Society for Stereotactic and Functional Neurosurgery. We supplemented our investigation by reviewing additional publications by the major groups undertaking deep brain stimulation for mood disorders.

Results: We selected 10 open studies reporting on eight cohorts of patients using four different operative targets. All published studies reported positive results. This was not replicated in data available from the randomised, placebo-controlled trials. Many studies reported suicide or suicide attempts in the postoperative period.

Conclusion: We consider the placebo effect, the pattern of network activation, surgical candidacy and design of a blinded trial including the length of a crossover period. We suggest a greater focus on selecting patients with melancholia. We anticipate that methodological refinements may facilitate further investigation of this technology for intractable depression. We conclude by noting the psychiatric adverse events that have been reported in the literature to date, as these will also influence the design of future trials of deep brain stimulation for depression.
Keyword Deep brain stimulation
Depression
Melancholia
Tractography
Randomised controlled trial
Suicide
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2016 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 17 Nov 2015, 02:17:15 EST by System User on behalf of Scholarly Communication and Digitisation Service