Deep brain stimulation (DBS) is currently used successfully in a limited group of patients with major depression or obsessive-compulsive disorder. However, this treatment may be able to help many more patients. Amsterdam UMC researcher and psychiatrist-in-training Gosse Mol explains: “Depression can manifest itself in many different ways in patients. There are all sorts of ideas about which ’type’ of depression can or cannot be effectively treated with DBS. As a result, many patients are still excluded from receiving DBS.” Research from Amsterdam UMC now shows that these ideas are incorrect, as no factors are known that can predict the effect of DBS in patients with depression. This suggests that DBS could potentially be offered to a broader group of patients.

When people have tried (almost) all regular treatments for depression, DBS may still be able to help. DBS is an advanced treatment used for neurological and psychiatric disorders. Through implanted electrodes, electrical signals are delivered to specific brain regions to regulate brain activity. Within psychiatry, DBS is primarily used in patients with obsessive-compulsive disorder or severe depression. Patients who have not sufficiently improved after previous treatments often experience symptom reduction after DBS treatment. Nevertheless, DBS is still rarely used in psychiatry.

Predictions

Researchers at Amsterdam UMC investigated whether the effect of DBS in people with depression can be predicted in advance. To do so, they analysed 7,766 scientific articles and 22 studies containing data from 294 patients. Their analysis shows that there are no strong factors that can reliably predict whether or not DBS will be effective. Currently, it is often assumed that DBS will not help patients, but this assumption is not supported by scientific evidence, according to this study by Mol et al.

Gosse Mol emphasizes the importance of diligence in selecting patients with depression for DBS treatment.

“In some studies, hundreds of people are screened for eligibility, but the vast majority of them are excluded. We found no evidence that the selected characteristics were predictive of treatment success.”
Gosse Mol
Psychiatry Resident

Excluding patients

Mol warns that excluding patients based on assumptions is risky. “The results of this study do not mean that there are no characteristics that can predict whether DBS is successful in patients with depression, but rather that we do not yet know what those characteristics are. If we exclude so many people, we also limit our ability to investigate this further.” Therefore, at Amsterdam UMC, each patient is carefully examined. “We always decide whether or not to treat with DBS in close consultation with the patient, family, and previous practitioners who know the patient well,” Mol said.

Read the publication in the Journal of Affective Disorders: Pre-operative predictors of response to deep brain stimulation in depression: A systematic review and meta-analysis.

Source: Amsterdam UMC

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