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Deep Brain Stimulation in Depression: Background, Progress, and Key Issues

  • Chapter
Deep Brain Stimulation in Neurological and Psychiatric Disorders

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Deep brain stimulation (DBS) is an approved adjunct therapy for severe, medication-refractory movement disorders, though it is currently investigational in neuropsychiatry and other neurological conditions. In movement disorders, DBS targets are based mainly on rationales derived from earlier lesion procedures and on knowledge of anatomical networks thought to be involved in pathophysiology of illness. In contrast to lesions DBS is nonablative and has the advantages of reversibility and adjustability. Thus, therapeutic effectiveness can be enhanced and stimulation-related side effects can be minimized during long-term patient management. Preclinical and clinical studies have shown effects of DBS on brain regions that are functionally connected to the stimulation target. Understanding the mechanism of action of DBS constitutes the current focus of a number of clinical and preclinical laboratories. Experience to date, which remains very limited, has suggested that DBS may offer hope to patients with severe and treatment-resistant neuropsychiatric illness. Thus far, work in obsessive—compulsive disorder (OCD), the first neuropsychiatric condition studied using modern DBS devices, has shown consistently positive results across multiple small-scale studies. Work in treatment-resistant depression, where there also may be therapeutic potential, is at an earlier stage. Early positive results have generated cautious optimism in this group of patients. Further development of DBS for these and other illnesses with primarily behavioral symptoms will require thoughtful collaboration among multiple disciplines. Psychiatrists and neurosurgeons, in particular, have only recently begun working together in a limited way. These and other disciplines will need to enhance their interactions as part of dedicated teams for best outcomes in research and ultimately in clinical practice.

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Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI

    Benjamin D. Greenberg

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Editors and Affiliations

  1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel Tarsy MD  & Daniel Tarsy MD  & 

  2. Neuromodulation Research Center, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Jerrold L. Vitek MD, PhD

  3. Department of Neurosurgery, University of California, San Francisco, CA, USA

    Philip A. Starr MD, PhD

  4. Departments of Neurology and Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, FL, USA

    Michael S. Okun MD

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Greenberg, B.D. (2008). Deep Brain Stimulation in Depression: Background, Progress, and Key Issues . In: Tarsy, D., Vitek, J.L., Starr, P.A., Okun, M.S. (eds) Deep Brain Stimulation in Neurological and Psychiatric Disorders. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59745-360-8_25

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