Deep Brain Stimulation in Treatment-Resistant Depression: A Systematic Review and Meta-Analysis on Efficacy and Safety

Summary & key facts

This paper reviewed 17 studies of deep brain stimulation (DBS) for people with treatment-resistant depression. Across studies, 56% of patients showed a clinical response (range 43%–69%), 35% reached remission (27%–44%), and 14% later had a recurrence (4%–25%). Adverse events were common (67%, range 54%–80%) and were often moderate; suicide-related problems were noted. Only two randomized controlled trials compared DBS with control and produced an imprecise result (rate ratio 1.45, 95% CI 0.50–4.21). The authors say DBS appears promising but that larger, better trials and more research are needed to confirm benefits and understand how it works.

Key facts:

• The review pooled results from 17 studies that used DBS at seven different brain targets.
• Across studies the pooled response rate was 56% (reported study ranges 43%–69%).
• The pooled remission rate was 35% (study ranges 27%–44%).
• The pooled recurrence (relapse) rate after DBS was 14% (study ranges 4%–25%).
• Adverse events were reported in 67% of patients (study ranges 54%–80%), and were described as common and often moderate.
• Only two randomized controlled trials contributed direct controlled comparisons; their combined rate ratio was 1.45 with a wide 95% confidence interval (0.50–4.21), indicating uncertainty about benefit in RCT evidence.
• The authors concluded that DBS is promising for treatment-resistant depression but needs larger, well-designed clinical trials and more basic research to confirm efficacy and clarify mechanisms.

Abstract

Objective: Deep brain stimulation (DBS) has shown promising outcomes as new therapeutic opportunities for patients with treatment-resistant depression (TRD) who do not respond adequately to several consecutive treatments. This study aims to systematically review and conduct a meta-analysis on the efficacy and safety of DBS for TRD. Method: The literature was comprehensively reviewed using Medline, Google scholar, Cochrane library, Embase, and World Health Organization International Clinical Trials Registry Platform until January 2019. The studied outcomes included response, remission, recurrence, and adverse events (AEs) rates, and were reported as the rate ratio (RR) or pooled estimate with a 95% confidence interval (95% CI). Heterogeneity was measured by an I-square test and a sensitive analysis. Results: A total of 17 studies involving 7 DBS targets were included. For efficacy, DBS treatment was statistically beneficial for TRD, and the response, remission, and recurrence rates were 56% (ranging from 43 to 69%), 35% (ranging from 27 to 44%), and 14% (ranging from 4 to 25%), respectively. However, only two randomized-controlled trials (RCTs) considered the invalidity of DBS (RR = 1.45, 95% CI = 0.50-4.21). For safety, the AEs rate was 67% (ranging from 54 to 80%). The AEs were common and moderate, but the problems related to suicide and suicidal ideation should not be underestimated. Conclusion: These findings suggest that DBS for TRD is considered promising, which should be confirmed by well-designed and large sample studies. Future basic research and comprehensive clinical trials are needed to reach better understanding on the mechanisms of action and optimal targeted structure.

Topics

Neurological disorders and treatments Parkinson's Disease Mechanisms and Treatments Transcranial Magnetic Stimulation Studies

Categories

Health Sciences Medicine Neurology

Tags

Adverse effect Amygdala Clinical trial Cochrane Library Confidence interval Deep brain stimulation Depression (economics) Disease Economics Emergency medicine Injury prevention Internal medicine Law Macroeconomics Major depressive disorder Medicine MEDLINE Meta-analysis Parkinson's disease Poison control Political science Randomized controlled trial Suicidal ideation Treatment-resistant depression

Conditions & symptoms

Depression Sadness or low mood