title: Deep brain stimulation for psychiatric disorders: where we are now.
abstract: Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.
authors.affiliation: 1Department of Neurology, Yale Medical School, New Haven, Connecticut;
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Cleary
authors.forename: Alp
authors.initials: A
authors.lastname: Ozpinar
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Raslan
authors.affiliation: 3Department of Neurological Surgery, University of Washington, Seattle, Washington.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ko
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards / Q000639:trends; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*
keywords: ALIC = anterior limb of the internal capsule; AN = anorexia nervosa; BDI = Beck Depression Inventory; BMI = body mass index; CM-PF = centromedian-parafascicular thalamic complex; DBS = deep brain stimulation; ECT = electroconvulsive therapy; GAF = Global Assessment of Functioning; GP = globus pallidus; GPi = GP internus; HDRS = Hamilton Depression Rating Scale; ITP = inferior thalamic peduncle; LHb = lateral habenula; MADRS = Montgomery-Asberg Depression Rating Scale; MDD = major depressive disorder; MFB = medial forebrain bundle; NAcc = nucleus accumbens; OCD = obsessive-compulsive disorder; PD = Parkinson disease; PTSD = posttraumatic stress disorder; SCC = subcallosal cingulate cortex; STN = subthalamic nucleus; TRD = treatment-resistant depression; TS = Tourette syndrome; VCA/S = ventral capsule and ventral striatum; VTA = ventral tegmental area; YBOCS = Yale-Brown Obsessive-Compulsive Scale; YGTSS = Yale Global Tic Severity Score; deep brain stimulation; pHr = posterior hypothalamic region; psychiatric disease; psychosurgery