Deep Brain Stimulation for Highly Refractory Depression

Deep brain stimulation (DBS) as an investigational treatment in neuropsychiatry has generated considerable interest. The pathophysiology of psychiatric conditions is poorly understood, leading to investigation of therapeutic effects at several different DBS targets. Although its mechanisms of therapeutic action are not completely understood, DBS can precisely target regions and circuits deep within the brain that are hypothesized to be centrally involved in neuropsychiatric disorders. Relative to surgical lesion therapies, DBS offers the advantages of reversibility and adjustability, which might permit effectiveness to be enhanced or side-effects to be minimized. While results from pilot studies suggest DBS may offer a degree of hope for patients with severe and highly treatment-resistant neuropsychiatric illness, only one of three controlled trials to evaluate efficacy and safety fully has yielded positive results. Research to realize the potential of DBS in this domain requires a considerable commitment of resources and time across disciplines including psychiatry, neurosurgery, neurology, neuropsychology, bioengineering, and bioethics. Limited evidence available at present suggests that, with the appropriate multidisciplinary work, cautious optimism about the role of DBS in psychiatric treatment is justified.