Curr Psychiatry Rep. 2013 Jul;15(7):368. doi: 10.1007/s11920-013-0368-1.

What is the role of brain stimulation therapies in the treatment of depression?

Blumberger DM, Mulsant BH, Daskalakis ZJ.

Source

Campbell Family Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 1001 Queen St. W. Unit 4, Room 115, Toronto, ON, M6J 1H4, Canada, daniel.blumberger@camh.ca.

Abstract

Brain stimulation therapies have demonstrated efficacy in the treatment of depression and treatment-resistant depression (TRD). Non-invasive brain stimulation in the treatment of depression has grown substantially due to their favorable adverse effect profiles. The role of transcranial direct current stimulation in TRD is unclear, but emerging data suggests that it may be an effective add-on treatment. Repetitive transcranial magnetic stimulation has demonstrated efficacy in TRD that is supported by several multicenter randomized controlled trials. Though, vagus nerve stimulation has been found to be effective in some studies, sham controlled studies were equivocal. Electroconvulsive therapy (ECT) is a well-established brain stimulation treatment for severe depression and TRD, yet stigma and cognitive adverse effects limit its wider use. Magnetic seizure therapy has a more favorable cognitive adverse effect profile; however, equivalent efficacy to ECT needs to be established. Deep brain stimulation may play a role in severe TRD and controlled trials are now underway.

PMID:

23712719

[PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/23712719

Patient Prefer Adherence. 2012;6:369-88. Epub 2012 May 1.

Treatment-resistant depression: therapeutic trends, challenges, and future directions.

Al-Harbi KS.

Source

Medical College, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Abstract

BACKGROUND:

Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options.

METHODS:

In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review.

RESULTS:

Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression.

CONCLUSION:

Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.

PMID:

22654508

[PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/22654508

Related citations in PubMed

• Review Therapeutic options for treatment-resistant depression.[CNS Drugs. 2010]
  Review Therapeutic options for treatment-resistant depression.

  Shelton RC, Osuntokun O, Heinloth AN, Corya SA. CNS Drugs. 2010 Feb; 24(2):131-61.
• Review Treatment resistant depression--advances in somatic therapies.[Ann Clin Psychiatry. 2007]
  Review Treatment resistant depression--advances in somatic therapies.

  Kennedy SH, Giacobbe P. Ann Clin Psychiatry. 2007 Oct-Dec; 19(4):279-87.
• Review Treatment-resistant depression: no panacea, many uncertainties. Adverse effects are a major factor in treatment choice.[Prescrire Int. 2011]
  Review Treatment-resistant depression: no panacea, many uncertainties. Adverse effects are a major factor in treatment choice.

  . Prescrire Int. 2011 May; 20(116):128-33.
• Review Treatment-resistant depression: new therapies on the horizon.[Ann Clin Psychiatry. 2003]
  Review Treatment-resistant depression: new therapies on the horizon.

  Trivedi MH. Ann Clin Psychiatry. 2003 Mar; 15(1):59-70.
• No health without mental health: A role for the cochrane collaboration.[Cochrane Database Syst Rev. 2010]

Aust N Z J Psychiatry. 2011 Nov;45(11):923-38.

The emerging use of brain stimulation treatments for psychiatric disorders.

Fitzgerald PB.

Source

Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia. paul.fi tzgerald@monash.edu

Abstract

OBJECTIVE:

The aim of this study was to review the current state of development and application of a wide range of brain stimulation approaches in the treatment of psychiatric disorders.

METHOD:

The approaches reviewed include forms of minimally invasive magnetic and electrical stimulation, seizure induction, implanted devices and several highly novel approaches in early development.

RESULTS:

An extensive range of brain stimulation approaches are now being widely used in the treatment of patients with psychiatric disorders, or actively investigated for this use. Both vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS) have been introduced into clinical practice in some countries. A small body of research suggests that VNS has some potentially long-lasting antidepressant effects in a minority of patients treated. rTMS has now been extensively investigated for over 15 years, with a large body of research now supporting its antidepressant effects. Further rTMS research needs to focus on defining the most appropriate stimulation methods and exploring its longer term use in maintenance protocols. Very early data suggest that magnetic seizure therapy (MST) has promise in the treatment of patients referred for electroconvulsive therapy: MST appears to have fewer side effects and may have similar efficacy. A number of other approaches including surgical and alternative forms of electrical stimulation appear to alter brain activity in a promising manner, but are in need of evaluation in more substantive patient samples.

CONCLUSIONS:

It appears likely that the range of psychiatric treatments available for patients will grow over the coming years to progressively include a number of novel brain stimulation techniques.

PMID:

22044172

[PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/22044172

Aust N Z J Psychiatry. 2011 Nov;45(11):923-938.

The emerging use of brain stimulation treatments for psychiatric disorders.

Fitzgerald PB.

Source

Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry , The Alfred, First Floor Old Baker Building, Commercial Road, Melbourne, Victoria, 3004 , Australia.

Abstract

Objective: The aim of this study was to review the current state of development and application of a wide range of brain stimulation approaches in the treatment of psychiatric disorders. Method: The approaches reviewed include forms of minimally invasive magnetic and electrical stimulation, seizure induction, implanted devices and several highly novel approaches in early development. Results: An extensive range of brain stimulation approaches are now being widely used in the treatment of patients with psychiatric disorders, or actively investigated for this use. Both vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS) have been introduced into clinical practice in some countries. A small body of research suggests that VNS has some potentially long-lasting antidepressant effects in a minority of patients treated. rTMS has now been extensively investigated for over 15 years, with a large body of research now supporting its antidepressant effects. Further rTMS research needs to focus on defining the most appropriate stimulation methods and exploring its longer term use in maintenance protocols. Very early data suggest that magnetic seizure therapy (MST) has promise in the treatment of patients referred for electroconvulsive therapy: MST appears to have fewer side effects and may have similar efficacy. A number of other approaches including surgical and alternative forms of electrical stimulation appear to alter brain activity in a promising manner, but are in need of evaluation in more substantive patient samples. Conclusions: It appears likely that the range of psychiatric treatments available for patients will grow over the coming years to progressively include a number of novel brain stimulation techniques.

PMID:

22044172

[PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/22044172