A narrative review on invasive brain stimulation for treatment-resistant depression

Manoj P. Dandekar; Alexandre P. Diaz; Ziaur Rahman; Ritele H. Silva; Ziad Nahas; Scott Aaronson; Sudhakar Selvaraj; Albert J. Fenoy; Marsal Sanches; Jair C. Soares; Patricio Riva-Posse; Joao Quevedo

doi:10.1590/1516-4446-2021-1874

A narrative review on invasive brain stimulation for treatment-resistant depression

Manoj P. Dandekar, Alexandre P. Diaz, Ziaur Rahman, Ritele H. Silva, Ziad Nahas, Scott Aaronson, Sudhakar Selvaraj, Albert J. Fenoy, Marsal Sanches, Jair C. Soares, Patricio Riva-Posse, Joao Quevedo

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.

Original language	English (US)
Pages (from-to)	317-330
Number of pages	14
Journal	Revista Brasileira de Psiquiatria
Volume	44
Issue number	3
DOIs	https://doi.org/10.1590/1516-4446-2021-1874
State	Published - May 1 2022

Bibliographical note

Funding Information:
MPD and ZR authors would like to thank the Department of Pharmaceuticals, the Ministry of Chemicals and Fertilizers, the Government of India, and the National Institute of Pharmaceutical Education and Research of Hyderabad for financial support. The Translational Psychiatry Program (United States) is funded by a grant from the National Institute of Health/National Institute of Mental Health (1R21MH117636-01A1, to JQ). The Center of Excellence on Mood Disorders (United States) is funded by the Pat Rutherford Jr. Chair in Psychiatry, the John S. Dunn Foundation, and the Anne and Don Fizer Foundation Endowment for Depression Research. The Translational Psychiatry Laboratory (Brazil) is funded by grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), the Coordenac¸ão de Aperfeic¸oamento de Pessoal de Nível Superior (CAPES), the Fundac¸ão de Amparo à Pesquisa e Inovac¸ão do Estado de Santa Catarina (FAPESC), and the Instituto Cérebro e Mente.

Funding Information:
MPD and ZR authors would like to thank the Department of Pharmaceuticals, the Ministry of Chemicals and Fertilizers, the Government of India, and the National Institute of Pharmaceutical Education and Research of Hyderabad for financial support. The Translational Psychiatry Program (United States) is funded by a grant from the National Institute of Health/National Institute of Mental Health (1R21MH117636-01A1, to JQ). The Center of Excellence on Mood Disorders (United States) is funded by the Pat Rutherford Jr. Chair in Psychiatry, the John S. Dunn Foundation, and the Anne and Don Fizer Foundation Endowment for Depression Research. The Translational Psychiatry Laboratory (Brazil) is funded by grants from the Conselho Nacional de Desenvolvimento Cientí-fico e Tecnológico (CNPq), the Coordenac¸ão de Aper-feic¸oamento de Pessoal de Nível Superior (CAPES), the Fundac¸ão de Amparo à Pesquisa e Inovac¸ão do Estado de Santa Catarina (FAPESC), and the Instituto Cérebro e Mente.

Publisher Copyright:
© 2022, Associacao Brasileira de Psiquiatria. All rights reserved.

Keywords

Treatment-resistant depression
deep brain stimulation
epidural cortical stimulation subcallosal cingulate gyrus
medial forebrain bundle
vagus nerve stimulation
Brain
Humans
Psychotherapy
Depression
Deep Brain Stimulation/methods
Depressive Disorder, Treatment-Resistant/therapy

PubMed: MeSH publication types

Review
Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1590/1516-4446-2021-1874

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abstract = "While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.",

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author = "Dandekar, {Manoj P.} and Diaz, {Alexandre P.} and Ziaur Rahman and Silva, {Ritele H.} and Ziad Nahas and Scott Aaronson and Sudhakar Selvaraj and Fenoy, {Albert J.} and Marsal Sanches and Soares, {Jair C.} and Patricio Riva-Posse and Joao Quevedo",

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AU - Nahas, Ziad

AU - Aaronson, Scott

AU - Selvaraj, Sudhakar

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AU - Sanches, Marsal

AU - Soares, Jair C.

AU - Riva-Posse, Patricio

AU - Quevedo, Joao

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AB - While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.

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KW - Deep Brain Stimulation/methods

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A narrative review on invasive brain stimulation for treatment-resistant depression

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

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