Abstract
Major depressive disorder (MDD) affects approximately 4.4% of the world’s population. One third of MDD patients do not respond to routine psychotherapeutic and pharmacotherapeutic treatment and are said to suffer from treatment-resistant depression (TRD). Deep brain stimulation (DBS) is increasingly being investigated as a treatment modality for TRD. Although early case studies showed promising results of DBS, open-label trials and placebo-controlled studies have reported inconsistent outcomes. This has raised discussion about the correct interpretation of trial results as well as the criteria for patient selection, the choice of stimulation target, and the optimal stimulation parameters. In this narrative review, we summarize recent studies of the effectiveness of DBS in TRD and address the relation between the targeted brain structures and clinical outcomes. Elaborating upon that, we hypothesize that the effectiveness of DBS in TRD can be increased by a more personalized and symptom-based approach. This may be achieved by using resting-state connectivity mapping for neurophysiological subtyping of TRD, by using individualized tractography to help decisions about stimulation target and electrode placement, and by using a more detailed registration of symptomatic improvements during DBS, for instance by using ‘experience sampling’ methods.
Highlights
Major depressive disorder (MDD) is a common mood disorder that affects one’s feelings, thoughts, and behavior
Another brain region involved in MDD is the nucleus accumbens (NAcc), part of the mesolimbic dopaminergic circuit involved in different cognitive functions such as motivation and reward [33] (Table 2)
The first randomized controlled trial (RCT) of deep brain stimulation (DBS) of the ventral part of the ALIC (vALIC) for Treatment-resistant depression (TRD) was conducted by Bergfeld et al (2016), investigating 25 TRD patients during a 52 week open-label trial, which resulted in a significant decrease in Hamilton Depression Rating Scale (HDRS) scores in the whole group during the optimization phase, overall HDRS scores were still in the depression range (22.2 at baseline vs. 15.9 after optimization phase)
Summary
Major depressive disorder (MDD) is a common mood disorder that affects one’s feelings, thoughts, and behavior. Various alternative treatment options for TRD are currently being investigated, including vagal nerve stimulation [8], repetitive transcranial magnetic stimulation (rTMS) [9], and deep brain stimulation (DBS) [10] The aim of this narrative review is to provide an overview of recent studies of the effectiveness of DBS in TRD with a special focus on the relationship between the targeted brain structures and clinical outcomes. Based on these findings, we discuss the importance of distinguishing between different clinical phenotypes of depression that would allow for more personalized symptom-based treatment approaches, which may be a key factor in improving treatment outcomes
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