Deep Brain Stimulation Efficacious for Treatment Resistant Depression

JAMA Psychiatry

Deep Brain Stimulation (DBS) is an evolving therapy for psychiatric disorders, specifically treatment-resistant depression (TRD). In this study by Bergfeld and colleagues, stimulation of the ventral anterior limb of the internal capsule (vALIC) for TRD is revisited with a more robust open-label optimization phase with subsequent randomized, double-blind cross-over active-sham phase. Of 25 patients recruited, 10 patients (40%) demonstrated significant improvement in Hamilton Depression Rating Scale (HAM-D-17) with vALIC DBS. Following the optimization phase, 16 patients entered the randomized crossover phase (9 responders, 7 nonresponders). Active stimulation was found to significantly lower the HAM-D-17 score (13.6 [95% CI, 9.8-17.4]) compared to sham stimulation (23.1 [95% CI, 20.6-25.6]) (P < .001). Therefore, DBS of the vALIC led to a significant decrease in depressive symptoms in 10 of 25 patients and more importantly the crossover design of this study corroborates this when compared to sham stimulation. This study not only shows efficacy of DBS in TRD, despite previous randomized clinical trials, but also implements an effective and robust study model for studying the efficacy of neuromodulation for psychiatric disorders moving forward.

Shervin Rahimpour, MD
Durham, NC
Shivanand P. Lad, MD, PhD
Durham, NC