Treatment resistant depression as a failure of brain homeostatic mechanisms: implications for deep brain stimulation.

Abstract:

:Given the profound negative public health effects of major depressive disorder (MDD), and data suggesting only modest effectiveness of existing psychological and pharmacological treatments for this condition, there has been increasing interest in exploring the antidepressant potential of non-pharmacological, brain-based interventions, such as deep brain stimulation (DBS). The use of the DBS for psychiatric indications follows a decade of data suggesting that DBS is an effective, evidence-based strategy for the treatment of movement disorders such as Parkinson's disease. At the present time there is open-label case series data to suggest that DBS in the subgenual cingulate gyrus, ventral caudate/ventral striatum, and the nucleus accumbens, is associated with antidepressant effects in individuals who fail to respond to conventional treatments for MDD. However a number of unresolved issues about the optimal use of DBS for MDD remain, such as the optimal anatomical placement of the electrodes and the mechanisms of its antidepressant effects. This review summarizes the clinical experience of DBS for treatment resistant depression (TRD). The rationale for the use of DBS for TRD is reviewed in the context of the growing neuroimaging literatures exploring the biomarkers of antidepressant response, and the neural substrates of emotional regulation in both normal and pathological states.

journal_name

Exp Neurol

journal_title

Experimental neurology

authors

Giacobbe P,Mayberg HS,Lozano AM

doi

10.1016/j.expneurol.2009.04.028

subject

Has Abstract

pub_date

2009-09-01 00:00:00

pages

44-52

issue

1

eissn

0014-4886

issn

1090-2430

pii

S0014-4886(09)00178-2

journal_volume

219

pub_type

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