Deep brain stimulation for treatment-resistant depression: a safe and effective option. (3rd May 2020)

• Record Type: Journal Article
• Authors: La Torre, Domenico; Della Torre, Attilio; Chirchiglia, Domenico; Volpentesta, Giorgio; Guzzi, Giusy; Lavano, Angelo
• Is Part Of: Expert review of neurotherapeutics. Volume 20:Number 5(2020)
• Page Start: 449
• Page End: 457
• Publication Date: 2020-05-03
• Subjects: Deep brain stimulation -- treatment resistant depression -- ventral capsule -- ventral striatum -- Brodmann area 25 -- subgenual cingulate -- nucleus accumbens; Neuropharmacology -- Periodicals; 615.7805
• DOI: 10.1080/14737175.2020.1749049
• Languages: English
• ISSNs: 1473-7175

Abstract

ABSTRACT: Introduction : Major depressive disorder (MDD) is the leading cause of years lost to disability worldwide. Pharmacotherapy and psychotherapy are effective treatments in most depressive episodes; but, about 30% of MDD patients remain symptomatic, and relapse is a common event. Recently, deep brain stimulation (DBS) has emerged as a valid therapeutic option in treatment-resistant depression (TRD) patients. Areas covered : In this paper, the authors summarize the findings of studies focused on these pathophysiologic phenomena and specifically on the role of DBS as a therapeutic option in TRD patients. The authors simply reviewed RCTs, open-label studies, neurophysiological mechanisms of DBS in MDD, and the possible role of different targets. Finally, we suggest possible future options. Expert opinion : Depression is a systems-level disorder, involving several brain structures. Neuroimaging studies demonstrate multiple interconnected regions that modulate different neural networks. DBS can modulate different targets, and others are under investigation. Among these subcallosal cingulate gyrus (SCG), ventral capsule and ventral striatum (VC/VS) seems to be the most relevant targets. We believe that, in the next future, DBS for TRD might become a first-line of treatment, especially using directional leads, that may help us to improve therapeutic effects.