TY - CHAP
T1 - Deep brain stimulation for major depression
AU - Schlaepfer, T. E.
AU - Bewernick, B. H.
PY - 2013
Y1 - 2013
N2 - A third of patients suffering from major depression cannot be helped by conventional treatment methods. These patients face reduced quality of life, high risk of suicide, and little hope of recovery. Deep brain stimulation (DBS) is under scientific evaluation as a new treatment option for these treatment-resistant patients. First clinical studies with small samples have been stimulated at the subgenual cingulate gyrus (Cg25/24), the anterior limb of the capsula interna (ALIC), and the nucleus accumbens (NAcc). Long-term antidepressant effects, augmentation of social functioning, and normalization of brain metabolism have been shown in about 50% of patients. Cognitive safety regarding attention, learning, and memory has been reported. Adverse events were wound infection, suicide, and hypomania, amongst others. Larger studies are under way to confirm these preliminary encouraging results. New hypothesis-guided targets (e.g., medial forebrain bundle, habenula) are about to be assessed in clinical trials. The application of DBS for other psychiatric diseases (e.g., bipolar disorder, alcohol dependency, opioid addiction, schizophrenia) is debated and single case studies are under way. Standards are needed for study registration, target selection, patient inclusion and monitoring, and publication of results to guarantee safety for the patients and scientific exchange.
AB - A third of patients suffering from major depression cannot be helped by conventional treatment methods. These patients face reduced quality of life, high risk of suicide, and little hope of recovery. Deep brain stimulation (DBS) is under scientific evaluation as a new treatment option for these treatment-resistant patients. First clinical studies with small samples have been stimulated at the subgenual cingulate gyrus (Cg25/24), the anterior limb of the capsula interna (ALIC), and the nucleus accumbens (NAcc). Long-term antidepressant effects, augmentation of social functioning, and normalization of brain metabolism have been shown in about 50% of patients. Cognitive safety regarding attention, learning, and memory has been reported. Adverse events were wound infection, suicide, and hypomania, amongst others. Larger studies are under way to confirm these preliminary encouraging results. New hypothesis-guided targets (e.g., medial forebrain bundle, habenula) are about to be assessed in clinical trials. The application of DBS for other psychiatric diseases (e.g., bipolar disorder, alcohol dependency, opioid addiction, schizophrenia) is debated and single case studies are under way. Standards are needed for study registration, target selection, patient inclusion and monitoring, and publication of results to guarantee safety for the patients and scientific exchange.
KW - Anterior limb of internal capsule
KW - Deep brain stimulation
KW - Ethical standards
KW - Major depression
KW - Medial forebrain bundle
KW - Neuromodulation
KW - Nucleus accumbens
KW - Reward system
KW - Subgenual cingulate gyrus
UR - http://www.scopus.com/inward/record.url?scp=84885144530&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84885144530&partnerID=8YFLogxK
U2 - 10.1016/B978-0-444-53497-2.00018-8
DO - 10.1016/B978-0-444-53497-2.00018-8
M3 - Chapter
C2 - 24112897
AN - SCOPUS:84885144530
T3 - Handbook of Clinical Neurology
SP - 235
EP - 243
BT - Handbook of Clinical Neurology
PB - Elsevier B.V.
ER -