Deep brain stimulation: Methods, indications, locations, and efficacy

There remain a sizable number of patients who are not helped by traditional forms of pharmacological or somatic psychiatric treatment or psychotherapy. After five years of treatment, 8% to 13% of patients suffering from major depression have a poor outcome (Keller et al., 1992), and 63.2% of patients included in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study did not achieve remission in the acute study phase (Rush et al., 2006). These patients are called “treatment resistant” and have been treated with several antidepressants (e.g., tricyclics, selective serotonin reuptake inhibitors), augmentation agents (e.g., lithium, antipsychotics), psychotherapy, and often electroconvulsive therapy (ECT). In obsessive-compulsive disorder (OCD), treatment resistance occurs in 10% to 40% (Ferrão et al., 2007; Keller and Baker, 1992). These patients have little hope of recovery, are substantially impaired, and do not enjoy a reasonable quality of life. Treatment-resistant psychiatric disorders are a significant source of worldwide disability (Murray and Lopez, 1997). For these patients, alternative treatment methods are needed. Here we review the method of deep brain stimulation (DBS), only recently applied in highly selected patients with treatment-resistant major depression or OCD. In this review, knowledge about the neurobiology of depression and OCD and historical treatment methods are outlined. Principles of DBS and reasons for the use of DBS in psychiatry are discussed. Targets have been chosen in a hypothesis-guided approach, and first results have demonstrated that DBS can manipulate pathological neural networks in major depression and OCD.