Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years

Abstract

These data suggest that in the long term, DBS remains a safe and effective treatment for treatment-resistant depression. Additional trials with larger samples are needed to confirm these findings.

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

“…About 45% of patients responded significantly (reduction in HDRS X50% in all studies) during the first 6 months of NAcc-DBS and reached the response threshold after 12 months of stimulation at the latest (for a detailed description of response during first year of follow-up see Bewernick et al (2010)). This response rate was similar to studies on other stimulation targets after 24 months, namely Cg 25 (Kennedy et al, 2011;Lozano et al, 2008) and ventral striatum (Malone, 2010;Malone et al, 2009) (Cg 25 : response rate 45% after 24 months, 55% at last follow-up; ventral striatum: response rate 53.3%) and 12 months (ventral striatum: response rate 53 after 12 months, 71% at last follow-up, ranging from 14 to 67 months).…”

“…Response rates of DBS in the present small sample as well as in other studies on Cg 25 (Kennedy et al, 2011) and ALIC seem to be substantially higher, keeping in mind that the selected patients were per inclusion criteria nonresponders to conventional treatments.…”

“…It has to be taken into account that severe depression is associated with a 4-5 times elevated risk for suicide compared with moderate or mild depression (Hardy, 2009). Given the high risk of suicide (approximately 15% in TRD) (Isometsa et al, 1994;Wulsin et al, 1999) and compared with the suicide rate found in DBS to Cg 25 (10%) (Kennedy et al, 2011), in our sample, the one tragic suicide of a patient (suicide rate in our sample 9%) still remains below statistical expectation. Therefore, and because the suicide was judged not to be related to the simulation (Bewernick et al, 2010), DBS as treatment option for TRD should not be abandoned because of risk of suicide, but close patient tracking is necessary as well as close collaboration with additional health care providers (local psychiatrist, psychotherapy, and professional social support).…”

“…All DBS studies so for are reporting on a relatively small number of patients, thus response ratios between 40 and 60% (Kennedy et al, 2011;Lozano et al, 2008;Malone et al, 2009;Mayberg et al, 2005) are limited in interpretation. Especially in long-term studies, dropouts, and patients who…”

Managing Suicide Risk in Experimental Treatments of Treatment-Resistant Depression

“…These include managing unrealistic patient expectations about the likely effectiveness of the treatment; ensuring that they appreciate the risks of the intervention; and ensuring that patients have the cognitive and motivational capacities to provide free and informed consent to study participation Patients who do not improve after DBS will probably be at greatest risk of suicide because they have failed to benefit from the treatment of last resort. This view is supported by studies showing that those who are unresponsive to DBS for TRD are more likely to develop postoperative SRB (Bewernick et al 2012;Kennedy et al 2011). This issue will need to be addressed in the study design and recruitment of participants into trials of experimental treatments for a life-threatening condition (Carter, Bartlett, and Hall 2009).…”