Deep Brain Stimulation in Treatment-Resistant Depression: A Systematic Review and Meta-Analysis on Efficacy and Safety

Abstract

Objective: Deep brain stimulation (DBS) has shown promising outcomes as new therapeutic opportunities for patients with treatment-resistant depression (TRD) who do not respond adequately to several consecutive treatments. This study aims to systematically review and conduct a meta-analysis on the efficacy and safety of DBS for TRD.Method: The literature was comprehensively reviewed using Medline, Google scholar, Cochrane library, Embase, and World Health Organization International Clinical Trials Registry Platform until January 2019. The studied outcomes included response, remission, recurrence, and adverse events (AEs) rates, and were reported as the rate ratio (RR) or pooled estimate with a 95% confidence interval (95% CI). Heterogeneity was measured by an I-square test and a sensitive analysis.Results: A total of 17 studies involving 7 DBS targets were included. For efficacy, DBS treatment was statistically beneficial for TRD, and the response, remission, and recurrence rates were 56% (ranging from 43 to 69%), 35% (ranging from 27 to 44%), and 14% (ranging from 4 to 25%), respectively. However, only two randomized-controlled trials (RCTs) considered the invalidity of DBS (RR = 1.45, 95% CI = 0.50–4.21). For safety, the AEs rate was 67% (ranging from 54 to 80%). The AEs were common and moderate, but the problems related to suicide and suicidal ideation should not be underestimated.Conclusion: These findings suggest that DBS for TRD is considered promising, which should be confirmed by well-designed and large sample studies. Future basic research and comprehensive clinical trials are needed to reach better understanding on the mechanisms of action and optimal targeted structure.

Stimulationsverfahren und Neurofeedback: neue Möglichkeiten zur Therapie und Rehabilitation?

“…Als recht erfolgreich hat sich dieses Verfahren zur Behandlung der Parkinson-Krankheit, von Dystonien, Zwangsstörungen, Tics und Epilepsie erwiesen 1 , 2 . Erste Studien lassen vermuten, dass DBS auch für die Behandlung von schweren Depressionen, Schizophrenien und chronischen Schmerzen hilfreich sein könnte 3 , 4 .…”

Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

“…As innovations in neurotechnology such as DBS continue to advance, the use of DBS in military members should be carefully assessed. While primarily used for restoration of health and function (e.g., PTSD or depression), there is a growing trend toward use of neuromodulation for cognitive or behavioral optimization (Lavano et al, 2018;Cinel et al, 2019;Wu et al, 2021). Studies have shown that the most concerning ethical, legal, and social implications of the use of neurotechnology in healthy individuals involves long term safety, invasiveness, reversibility, data security, device security, and social perceptions (Funk et al, 2016;Emanuel et al, 2021).…”

Neuromodulation Treatments of Pathological Anxiety in Anxiety Disorders, Stressor-Related Disorders, and Major Depressive Disorder: A Dimensional Systematic Review and Meta-Analysis

“…The mechanisms of action of DBS remain poorly understood, potentially involving depolarization of axonal fibers, excitation of local neurons (principal neurons and interneurons), or modulation of firingpatterns of neuronal populations (22). In MDD, TMS and tDCS have demonstrated clinical efficacy (25)(26)(27) and DBS has shown promising results (28,29). ADs and PTSD may benefit from TMS and tDCS, as summarized in several recent reviews (30)(31)(32)(33)(34) and meta-analyses of the literature (35)(36)(37).…”