Begin main content

Deep Brain Stimulation for Post-traumatic Stress Disorder or Treatment-resistant Depression: A Review of the Clinical Effectiveness

Last updated: October 6, 2014
Project Number: RC0592-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Post-traumatic stress disorder (PTSD) and major depressive disorder are common debilitating psychiatric conditions. Despite advances in the understanding of psychopharmacology and the introduction of new antidepressants, 30% to 40% of patients with these conditions do not respond to antidepressant therapy. For these patients, various non-drug treatments have been suggested, such as psychotherapy, electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation.

Technology
Deep brain stimulation involves implanting electrodes in certain regions of the brain to provide targeted electrical stimulation controlled by a "brain pacemaker" placed under the skin of the patient's chest. This stimulation is thought to be beneficial for managing treatment-resistant movement and affective disorders such as Parkinson disease, essential tremor, dystonia, chronic pain, Tourette syndrome, obsessive-compulsive disorder, and major depression. Recently, deep brain stimulation has been proposed for use in the treatment of PTSD.

Issue
A review of the clinical effectiveness of deep brain stimulation for the treatment of PTSD and treatment-resistant depression will help to inform treatment decisions for patients with these psychiatric disorders.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 481 citations, with 2 additional articles identified from other sources. Of these, 14 were deemed potentially relevant and 2 systematic reviews met the criteria for inclusion in this review.

Key Messages

  • Deep brain stimulation appears to be safe and effective for treatment-resistant depression (based on limited evidence).
  • More research is needed to confirm that the improvement in symptoms is due to deep brain stimulation and not other factors, such as the placebo effect or the natural course of the disease.
  • Whether severely depressed patients are capable of giving consent for treatment with deep brain stimulation is of concern.
  • No information was found on the effectiveness of deep brain stimulation for the treatment of PTSD.

Question

  1. What is the clinical effectiveness of deep brain stimulation for adults with treatment-resistance depression?
  2. What is the clinical effectiveness of deep brain stimulation for adults with post-traumatic stress disorder?

Key Message

In general, data from a systematic review that included mostly observational studies with small sample sizes found that between 40% and 70% of TRD patients treated with DBS showed at least 50% reduction in Hamilton Depression Rating Scale scores (HDRS) or Montgomery-Asberg Depression Rating Scale scores (MADRS). Response rates to DBS therapy and percentage of changes in depression scores after limited long-term follow-up did not vary significantly between anatomical targets. Meta-analyses of four pre-post observational studies on DBS therapy targeted to the SCC of TRD patients showed remission rate of 26% and drop-out rate of 11% after 12 months of treatment. In terms of safety, there were no serious complications reported except one case of temporary hemiparesis in one study. There were completed or attempted suicides, but the causality of DBS therapy to suicides cannot be proven due to the high risk of suicide in patients with severe depression. The low quality of the study designs (pre-post observational designs) limit the ability to prove causality between intervention (DBS) and outcomes (reduction of depression) in patients with TRD. The heterogeneity in patients’ characteristics and measurement tools among the included trials reduced the robustness and generalizability of findings of the evidence. There is lack of evidence on the clinical effectiveness of DBS on post-traumatic stress disorder.