Deep brain stimulation for treatment-resistant depression: an integrative review of preclinical and clinical findings and translational implications

被引:205
作者
Dandekar, M. P. [1 ]
Fenoy, A. J. [2 ]
Carvalho, A. F. [3 ,4 ]
Soares, J. C. [5 ]
Quevedo, J. [1 ,5 ,6 ,7 ]
机构
[1] Univ Texas Hlth Sci Ctr Houston UTHlth, McGovern Med Sch, Dept Psychiat & Behav Sci, Translat Psychiat Program, 1941 East Rd,Suite 3216, Houston, TX 77054 USA
[2] Univ Texas Hlth Sci Ctr Houston UTHlth, McGovern Med Sch, Dept Neurosurg, Houston, TX USA
[3] Univ Fed Ceara, Fac Med, Dept Clin Med, Fortaleza, Ceara, Brazil
[4] Univ Fed Ceara, Fac Med, Translat Psychiat Res Grp, Fortaleza, Ceara, Brazil
[5] Univ Texas Hlth Sci Ctr Houston, Ctr Excellence Mood Disorders, McGovern Med Sch, Dept Psychiat & Behav Sci, Houston, TX 77030 USA
[6] Univ Texas Houston, Grad Sch Biomed Sci, Neurosci Grad Program, Houston, TX USA
[7] Univ Southern Santa Catarina, Hlth Sci Unit, Grad Program Hlth Sci, Lab Neurosci, Criciuma, Brazil
关键词
MEDIAL FOREBRAIN-BUNDLE; OBSESSIVE-COMPULSIVE DISORDER; VENTRAL TEGMENTAL AREA; SUBCALLOSAL CINGULATE GYRUS; INFERIOR THALAMIC PEDUNCLE; HIGH-FREQUENCY STIMULATION; PREFRONTAL CORTEX STIMULATION; SUBGENUAL ANTERIOR CINGULATE; VAGUS NERVE-STIMULATION; MAJOR DEPRESSION;
D O I
10.1038/mp.2018.2
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
引用
收藏
页码:1094 / 1112
页数:19
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