Neuromodulation for treatment-refractory major depressive disorder

Lipsman, Nir; Sankar, Tejas; Downar, Jonathan; Kennedy, Sidney H.; Lozano, Andrés M.; Giacobbe, Peter

doi:10.1503/cmaj.121317

Cited by 38 publications

(22 citation statements)

References 55 publications

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“…Depression has long been known, 13 and so has neuromodulation through electricity and invasive brain procedures, inasmuch as Hippocrates (469-399 BCE) described trepanation for the management of intracranial hypertension. 14,15 Ancient Greek doctors modulated pain with electric eels.…”

Section: Historical Remarksmentioning

confidence: 99%

Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

2019

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Depression is the leading cause of disability worldwide, and it is related to high suicide rates. Furthermore, a great number of patients do not respond to any of the available treatments. Deep brain stimulation (DBS), a versatile technology with expanding indications, is considered a potential treatment for resistant depression. However, in over 10 years of clinical research, its efficacy has not been completely proven. Although new trials using DBS for treatment-resistant depression keep emerging, two of the three Level I evidence-based studies recently conducted have not provided conclusive data. Methodological limitations and major biases have compromised the obtention of clearer results. In this systematic review of the literature, we intend to critically assess the clinical trials performed in this field.

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Section: Historical Remarksmentioning

confidence: 99%

Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

2019

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“…Efficacy. ECT has level I evidence for acute efficacy and relapse prevention, and level II for safety and tolerability 22 (see Table 1 ). Transient cognitive side effects, such as postictal confusion and anterograde amnesia, are frequent and more pronounced in bilateral electrode placement as compared to unilateral electrode placement 23 , 24 .…”

Section: Treatmentsmentioning

confidence: 99%

Update on Neuromodulation for Treatment-Resistant Depression

Bewernick

Schläepfer

2015

F1000Res

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About 30% of patients suffering from a major depressive disorder do not respond sufficiently to established pharmacological, psychotherapeutic, or somatic treatments. Advances in technology and emerging knowledge about the dysfunctional brain circuits underlying depression have led to the development of different neuromodulation techniques. The aim of the present review is to give an update on noninvasive techniques, such as electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS), and invasive techniques requiring brain surgery, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). First, the clinical relevance for therapy-resistant depression, including the current level of evidence, are presented.Neuroethics is concerned with the ethical, legal and social policy implications of neuroscience. A second focus of the review is the application of fundamental ethical principles, such as patient autonomy, patient well-being and justice to neuromodulation therapies. Due to reduced availability and lacking long-term efficacy data, most patients with treatment-resistant depression face a trial-and-error approach to therapeutics. This contravenes the ethical criteria of patient autonomy and justice. In order to raise the level of evidence, financial support of long-term studies, including large samples and randomized control trials, are necessary.

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“…The management of mood and anxiety disorders is pharmacologic and psychotherapeutic, and for the majority of patients these approaches are effective. However, up to a third remain symptomatic despite optimal care, and are eligible for neuromodulation, including electroconvulsive-therapy, transcranial magnetic stimulation, DBS, and ablative or lesional procedures [81]. The most common ablative procedures for depression and obsessive-compulsive disorder (OCD) are cingulotomy and anterior capsulotomy.…”

Section: Major Depression and Obsessive-compulsive Disordermentioning

confidence: 99%

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

et al. 2014

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The ability to focus acoustic energy through the intact skull on to targets millimeters in size represents an important milestone in the development of neurotherapeutics. Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel, noninvasive method, which-under real-time imaging and thermographic guidance-can be used to generate focal intracranial thermal ablative lesions and disrupt the blood-brain barrier. An established treatment for bone metastases, uterine fibroids, and breast lesions, MRgFUS has now been proposed as an alternative to open neurosurgical procedures for a wide variety of indications. Studies investigating intracranial MRgFUS range from small animal preclinical experiments to large, late-phase randomized trials that span the clinical spectrum from movement disorders, to vascular, oncologic, and psychiatric applications. We review the principles of MRgFUS and its use for brain-based disorders, and outline future directions for this promising technology.

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Neuromodulation for treatment-refractory major depressive disorder

Cited by 38 publications

References 55 publications

Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

Update on Neuromodulation for Treatment-Resistant Depression

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

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