| A Comparative Clinical Trials Analysis of Deep Brain Stimulation for Major Depression |
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Soon-Tae You, Jae Hee Won, Young Seok Park |
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Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea, Department of General Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea |
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| Abstract |
Background
Deep brain stimulation (DBS) is remaining off-label clinical trials patients with treatment-resistant major depressive
disorder. The purpose of this comparative analysis was to evaluate the outcomes of studies of DBS for treatment-resistant depression.
Methods
We collected and compared PubMed published DBS for depression trials in this study. We searched and collected
Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, and Medline databases regarding “treatmentresistant depression” and “deep brain stimulation”. In total, our analysis evaluated nine studies (65 patients in total) that measured
DBS-related changes in Hamilton’s Rating Scale for Depression (HRDS) scores. Recent clinical trials also surveyed using http://
clinicals.gov.
Results
The mean age of patients at the time of DBS was 47.1 years (range: 35.5-64 years). Mean HRDS score was 28.3 before
DBS and 13.5 1 year after DBS. Anatomical targets of DBS included the inferior thalamic peduncle, lateral habenula, cingulate cortex 25, nucleus accumbens, and ventral capsule/ventral striatum. Out of 65 patients, 33 (50.8%) responded well to DBS, and 21
(33.9%) were considered as being in remission. There were no significant differences among anatomical targets in HRDS score
improvement. Relatively high voltage was needed for DBS of the lateral habenula (10.5V) and ventral capsule/ventral striatum
(6.7±1.8V). DBS-related adverse effects were trivial.
Conclusions
No consensus on proper DBS targets and methodologies was achieved, but the findings collectively support the
view that DBS is effective in alleviating treatment-resistant depression. Even if clinical trials are not optimistic, it is necessary to
perform a proper clinical trial on a specific targeted using a standardized patients. |
| Key Words:
Meta-analysis, Deep brain stimulation, Depression, Psychosurgery. |
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