Deep brain stimulation in the treatment of depression.
OBJECTIVE
To present the technique of deep brain stimulation (DBS) and to evaluate the studies conducted on DBS in the treatment of therapy-refractory major depressive disorder (MDD).


METHODS
A review of the literature on DBS in the treatment of MDD was conducted.


RESULTS
The results of DBS in MDD have been presented in 2 case reports and 3 studies of 47 patients operated upon in 5 different target areas. Positive effects have been presented in all studies and side effects have been minor. DBS in the nucleus accumbens resulted in a mean reduction of Hamilton depression rating scale (HDRS) of 36% after 1 year and 30% of the 10 patients achieved remission. DBS in the internal capsule/ventral striatum resulted in a reduction of 44% after 1 year, and at the last evaluation after in mean 2 years, 40% of the 15 patients were in remission. The 20 patients with subcallosal cingulated gyrus DBS had a reduction of HDRS of 52% after 1 year, and 35% were within 1 point from remission or in remission.


CONCLUSIONS
DBS is a promising treatment for therapy-refractory MDD. The published experience is, however, limited, and the method is at present an experimental therapy.
Department of Neurosurgery, University Hospital of Umeå, Sweden. patric.blomstedt@neuro.umu.se
P
P
Blomstedt
R L
RL
Sjöberg
M
M
Hansson
O
O
Bodlund
M I
MI
Hariz
D057186:Comparative Effectiveness Research; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D020772:Internal Capsule / Q000503:physiopathology; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D020379:Risk Adjustment; D035703:Therapies, Investigational / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome