Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Abstract

Deep brain stimulation (DBS) is currently under research for the treatment of psychiatric disorders, e.g., obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Since the application of DBS in psychiatry has been in use for about 20 years, it is necessary to evaluate its long-term use now. A main issue in the long-term treatment of DBS concerns the effects of a discontinuation of stimulation due to intended as well as unintended reasons. In this contribution, the literature describing discontinuation effects following DBS in OCD and TRD is reviewed. Furthermore, a patient is reported in depth who experienced an unintended discontinuation of supero-lateral medial forebrain bundle (slMFB) DBS for TRD. In this case, the battery was fully depleted without the patient noticing. DBS had led to a sustained response for seven years before discontinuation of stimulation for just several weeks caused a progressive worsening of depression. Altogether, the rapid occurrence of symptom worsening, the absence of a notification about the stimulation status and the difficulties to recapture antidepressant response represent important safety aspects. For a further understanding of the described effects, time courses until worsening of depression as well as biological mechanisms need to be investigated in double-blind controlled trials.

Normalized affective responsiveness following deep brain stimulation of the medial forebrain bundle in depression

“…Future studies are necessary to test the long-term stability of the demonstrated effects with the stimulation turned on and turned off. This is highly relevant given the fact that a discontinuation of stimulation is associated with a relapse of symptoms [ 16 ] as well as a reduction of quality of life [ 84 ].…”

“…DBS of the slMFB has shown promising results in terms of rapid and sustained antidepressant effects [ 11 – 15 ]. Beyond that, patients subjectively reported social functioning improvements [ 13 , 16 ]. Considering that normal social functioning is crucial for a good quality of life [ 17 , 18 ], reduces the mortality risk [ 19 ] and further plays an important role in the long-term stabilization after chronic diseases [ 20 ], it can be considered an important therapeutic outcome [ 9 ].…”