Deep brain stimulation for treatment-resistant depression: a psychiatric
perspective.
Current psychiatry reports, 8 (6):
437--44 (December 2006)Abstract
Traditionally, the therapeutic approach to treatment-resistant depression
(TRD) has relied on pharmacotherapy in various sequences and combinations,
in addition to evidence-based psychotherapy or electroconvulsive
therapy. Despite refinements to the existing therapeutic modalities,
there remains a significant subpopulation of severely ill patients
with refractory mood disorders who fail to achieve a clinical response
despite aggressive psychosocial and biological treatments. Interest
in the use of deep brain stimulation (DBS) for treatment-resistant
psychiatric illness has emerged in recent years for a number of reasons:
1) as part of a general re-evaluation of both noninvasive and invasive
brain stimulation techniques, 2) because of the demonstrated clinical
efficacy of DBS for movement disorders, and 3) as a logical consequence
of studies defining the functional neurocircuitry of several psychiatric
disorders. This review will examine the progress of DBS in the treatment
of Parkinson's disease and the potential implications for its use
in TRD, as well as the role of the psychiatrist in selection and
ongoing management of patients who receive this procedure.