Citation

Schlaepfer TE, Bewernick BH, Kayser S, Hurlemann R, Coenen VA. Neuropsychopharmacology 2014; 39(6): 1303-1314.

Copyright

(Copyright © 2014, Nature Publishing Group)

DOI

10.1038/npp.2014.28

PMID

unavailable

Abstract

Deep brain stimulation (DBS) as a putative approach for treatment-resistant depression (TRD) has now been researched for about a decade. Several uncontrolled studies - all in relatively small patient populations and different target regions - have shown clinically relevant antidepressant effects in about half of the patients and very recently, DBS to a key structure of the reward system, the medial forebrain bundle, has yielded promising results within few days of stimulation and at much lower stimulation intensities. On the downside, DBS procedures in regions are associated with surgical risks (eg, hemorrhage) and psychiatric complications (suicidal attenuation, hypomania) as well as high costs. This overview summarizes research on the mechanisms of brain networks with respect to psychiatric diseases and - as a novelty - extrapolates to the role of the reward system in DBS for patients with treatment-resistant depression. It further evaluates relevant methodological aspects of today's research in DBS for TRD. On the scientific side, the reward system has an important yet clearly under-recognized role in both neurobiology and treatment of depression. On the methodological side of DBS research in TRD, better animal models are clearly needed to explain clinical effects of DBS in TRD. Larger sample sizes, long-term follow-up and designs including blinded sham control are required to draw final conclusions on efficacy and side effects. Practical research issues cover study design, patient tracking, and the discussion of meaningful secondary outcome measures. © 2014 American College of Neuropsychopharmacology.

Language: en

Keywords

Humans; human; cognition; suicide; Animals; brain; bipolar disorder; Reward; white matter; major depression; treatment outcome; Brain; mood disorder; review; motivation; pathophysiology; priority journal; bleeding; nonhuman; follow up; hypomania; neurobiology; sample size; animal model; Parkinson disease; separation anxiety; reward; animal; brain depth stimulation; caudate nucleus; orbital cortex; subthalamic nucleus; Depressive Disorder, Major; cingulate gyrus; clinical effectiveness; Deep Brain Stimulation; neuroanatomy; surgical risk; clinical trial (topic); neuromodulation; nucleus accumbens; ventral tegmentum; stereotactic treatment; Neural Pathways; device safety; sham procedure; antidepressant activity; study design; capsula interna; functional neuroimaging; treatment resistant depression; dopaminergic nerve cell; nerve tract; deep brain stimulation; habenula; implantable neurostimulator; medial forebrain bundle; reward system