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Bipolar Depression: Molecular Neurobiology, Clinical Diagnosis, and Pharmacotherapy pp 243–258Cite as

Non-pharmacological Somatic Treatments for Bipolar Depression

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Part of the book series: Milestones in Drug Therapy ((MDT))

Abstract

There has been an explosion of research interest in noninvasive and invasive forms of brain stimulation as treatments for bipolar depression and major depressive disorder (MDD). Electroconvulsive therapy (ECT) has the strongest evidence base. In the short term, ECT is more effective than any other intervention for MDD. MDD patients and those with bipolar disorder (BD) do not differ in response or remission rates, but BD patients respond more quickly. Magnetic Seizure Therapy (MST) and Focal Electrically Administered Seizure Therapy (FEAST) provide greater focality of stimulation than can be achieved with traditional ECT. Both techniques appear to have reduced cognitive effects, but equivalence in efficacy with traditional ECT is not established. Repetitive Transcranial Magnetic Therapy (rTMS) is an approved and widely used treatment for MDD. Efficacy appears stronger in the community than in the randomized controlled trials, perhaps due to concomitant use of pharmacotherapy. While commonly used in bipolar depression, as yet there is little information on efficacy specifically in this subgroup. Small studies have suggested that transcranial Direct Current Stimulation (tDCS) has antidepressant properties, including in bipolar depression. While promising, multisite randomized sham controlled trials are needed to test these claims. Vagus Nerve Stimulation (VNS) showed long-term antidepressant effects and good durability of benefit in treatment-resistant depression, including BD. Lack of insurance reimbursement has limited use in the USA for this indication. Initial open-label studies of Deep Brain Stimulation (DBS) at several targets were encouraging. However, two recent pivotal trials were terminated due to lack of an efficacy signal. These negative findings are leading to rethinking the role of DBS in the treatment of severe, treatment-resistant depression.

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Authors and Affiliations

  1. Departments of Psychiatry and Radiology, College of Physicians and Surgeons of Columbia University, 2124 Moselem Springs Road, Fleetwood, PA, 19522, USA

    Harold A. Sackeim PhD

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  1. Harold A. Sackeim PhD
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Correspondence to Harold A. Sackeim PhD .

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Editors and Affiliations

  1. Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA

    Carlos A. Zarate Jr.

  2. Janssen Pharmaceuticals of Johnson and Johnson, Janssen Research and Development, Titusville, New Jersey, USA

    Husseini K. Manji

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Sackeim, H.A. (2016). Non-pharmacological Somatic Treatments for Bipolar Depression. In: Zarate Jr., C., Manji, H. (eds) Bipolar Depression: Molecular Neurobiology, Clinical Diagnosis, and Pharmacotherapy. Milestones in Drug Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-31689-5_11

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