New Data on DBS for Treatment-Resistant Depression

Peter M. Yellowlees, MB BS, MD


July 05, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Patients with treatment-resistant depression who do not respond adequately to several consecutive treatments for major depressive disorder are increasingly asking about deep brain stimulation (DBS) as an option, following a number of media reports of its efficacy. But is it really a promising treatment for these patients? Now, a team of investigators[1] from the University of Amsterdam in The Netherlands have assessed the efficacy of DBS on the ventral anterior limb of the internal capsule, controlling for placebo effects with active and sham stimulation phases.

Twenty-five patients with treatment-resistant depression entered a 52-week open-label trial during which they received bilateral implants of four contact electrodes, with 10 of the 25 patients improving significantly as measured by the Hamilton Depression Rating Scale (HAM-D-17). A randomized, double-blind, 12-week crossover phase was then conducted on 16 of the patients (nine responders and seven nonresponders) with patients receiving active treatment followed by sham, or vice versa.

During active DBS, patient scores for depression were significantly better than during the sham state, confirming that DBS probably caused the symptom reduction rather than a placebo effect of sham [therapy]. Serious adverse events included severe nausea during surgery (one patient), suicide attempt (four patients), and suicidal ideation (two patients).

So where does this leave us? This is a small study on patients with highly resistant depression, but it does demonstrate that DBS has some clinical effectiveness despite the serious adverse effects seen during the trial, which may have occurred anyway in this group of patients. Larger research trials are needed before this type of treatment can become common in clinical practice. This study does point optimistically toward the need for more examination of the brain pathways involved in depression, and of ways that we can modify them, ultimately leading to a range of new biological therapies.

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