Abstract
ObjectiveThis review aimed to investigate the therapeutic potential of Deep Brain Stimulation (DBS) for treating resistant Major Depressive Disorder (MDD). We explored the role of Nucleus accumbens (Nac) as a target for treatment.MethodWe made a systematic review of all studies examining the mechanisms of action of high frequency brain stimulation and the pathophysiology of MDD. We also reported all the studies exploring the therapeutic potential of DBS in MDD.ResultsAs a central relay-structure, the Nac seems to play a central role in MDD symptomatology. We investigated its role as a primary target for DBS in depressed patients. Anatomically the Nac is at the centre of the interactions between dopaminergic, serotoninergic and glutamatergic systems. Functionally, the Nac is involved in both normal and abnormal reward processes and in anhedonia and loss of motivation. Due to its central location between the emotional system, the cognitive system and motor control system, the Nac seems to have a central role in mood and feeling regulation.ConclusionAccording to encouraging recent studies, DBS seems to be a promising technique in resistant MDD treatment.
Highlights
Major depressive disorder (MDD) is a common psychiatric mood disorder
As a central relay-structure, the nucleus accumbens (Nac) seems to play a central role in MDD symptomatology
We investigated its role as a primary target for Deep Brain Stimulation (DBS) in depressed patients
Summary
Major depressive disorder (MDD) is a common psychiatric mood disorder. MDD consists of a single episode or several instances of recurrent or relapsed episodes of major depression. According to the DSM IV [1] major depression is characterized by depressed mood or loss of interest in daily activities. These symptoms can be associated with physical manifestations such as: significant weight loss or weight gain, insomnia or hypersomnia, diminished ability to think or concentrate and fatigue or loss of energy. ECT showed a higher efficacy in acute severe depression, psychotic depression and high level of treatment resistance. It is considered as the gold standard therapy for patient in TRD with 60% to 90% rate of acute response but with side effects such as acute cognitive impairment, arrhythmias, and headaches. This approach is not well adapted to chronic TRD as DBS might be
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