An illness known as the major depressive disorder can have devastating repercussions on a patient’s life. Pharmacotherapy, psychotherapy, and electroconvulsive therapy are often used treatments. The exploration of alternative therapeutic modalities has been prompted by the fact that many patients do not react to mainstream treatments. It has now been used successfully to treat psychiatric illnesses after initially treating movement abnormalities.
For patients with treatment-resistant depression (TRD) who do not respond well to numerous successive medications, deep brain stimulation (DBS) has demonstrated encouraging results as a novel therapeutic option. This study aims to conduct a systematic review and meta-analysis on the effectiveness and safety of DBS for TRD.
Although DBS is still a new treatment, preliminary studies on patients with treatment-resistant depression have shown promise efficacy and safety (TRD). The identification of some DBS targets was largely made possible by neuroimaging, which is still a valuable tool for analysing the mechanism of action of this innovative intervention.
Preclinical animal research has increased the understanding of potential DBS for TRD mechanisms of action. Ethics concerns regarding the ability to consent arise since DBS includes neurosurgery in patients with severe psychiatric impairment; these concerns must be carefully evaluated going forwards.
DBS is regarded as a successful TRD treatment.
The issues associated with suicide and suicidal ideation should not be understated, despite the fact that the AEs brought on by DBS were frequent and mild.
– In-depth clinical studies and basic research are required to understand the mechanisms of action and ideal modulatory structure fully.
The Deep Brain Stimulation procedure is now a widely accepted treatment because it has produced positive outcomes in the vast majority of people with Parkinson’s disease in its advanced stages. While individuals with Parkinson’s disease who underwent this surgery saw significant improvements in their ability to control their motor movements and other symptoms, there was not enough evidence up until recently to suggest that patients with depression could also benefit from this procedure.
However, treatment-resistant depression in patients, particularly for unipolar major depressive disorder (MDD) or bipolar II disorder, has been shown to be treatable thanks to medical studies on the subject, and DBS has been shown to be a promising alternative (BP). And DBS for depression is currently the subject of a lot of discussions.
Depression is a severe and disabling medical condition. Bipolar II disorder individuals are known to experience hypomania or manic episodes when using antidepressants. Still, MDD patients are more likely to become resistant to allopathic treatment and gradually immune to medication. For these reasons, DBS is the best option for these patients.
For a specific neuro-psychiatric disease, deep brain stimulation uses high-frequency electrical stimulation to target a particular area of the brain. While DBS has significantly improved the majority of individuals who have surgery for generalised depression, the majority of studies on the subject have produced contradictory findings.
The efficacy of DBS therapy for depression depends on patient selection. It is crucial to provide the patient with a surgical examination at a facility that is qualified to do so and has experience examining patients like this. Such individuals are examined by two psychiatrists and a neurosurgeon at the Jaslok hospital. They determine whether the condition is indeed incurable with medical intervention and whether the patient has received an adequate trial of the most effective medical treatments.
If they determine that it is appropriate, they refer him to a committee to certify the results; surgery is only offered after such a thorough assessment. The medicine and other therapies, including counselling, psychotherapy, rehabilitation, etc., may be continued even after the operation, even if it may aid the patient and cause a noticeable improvement. In some circumstances, DBS may not be the best course of action.
For such patients, conventional psychiatric or psychological care combined with allopathic medicine may be the only option right now, at least until another technological advancement can help.
It is critical to carry out more research and clinical studies on the topic since, although DBS for depression offers some people a glimmer of hope, it is still not the best option for everyone suffering from this condition. Many believe that a thorough knowledge of DBS and how it affects the brain can give researchers the knowledge they need to discover a treatment for depression and other mental illnesses.
How deep brain stimulation works
The nucleus accumbens, a part of the brain that regulates -motivation, mood, dopamine and serotonin production, is implanted surgically with tiny electrodes.
There are several steps to the process. The doctor first inserts the electrodes.. The electrodes are wired to a pacemaker-like implanted device in the chest that sends electrical pulses to the brain. The pulses, typically supplied continuously, seem to stop neurones from firing and bring the brain’s metabolism back to homoeostasis. A handheld gadget can programme and control the pacemaker from outside the body.
Despite the fact that doctors are unsure of why the pulses help the brain reset, the therapy seems to elevate mood and offer the patient a general sensation of tranquilly.
People have expressed relief from their depression and a noticeably improved quality of life in numerous DBS clinical trials. In addition to treating depression, doctors also utilise DBS to treat:
An obsessional condition
Dystonia and Parkinson’s disease,
high blood pressure
For those with persistent or treatment-resistant depression, DBS is a possibility. Before choosing DBS, doctors advise lengthy psychotherapy and pharmacological therapy courses because it requires an invasive surgical operation and has variable success rates. Although age is typically not a factor, doctors advise that you have sufficient health to tolerate major surgery.
DBS is typically regarded as a secure surgery. However, problems can always occur with brain surgery of any kind. DBS problems that are frequently experienced include:
a brain bleeding
a headache, an infection, or a stroke
problems with the senses or with movement
The necessity of more procedures is a different consideration. The battery life of the chest-implanted monitoring device is between six and 18 months, and it can break. If the treatment doesn’t seem to be working, the implanted electrodes may also need to be changed. You must decide if your health permits you to have a second or third surgery.