Deep Brain Stimulation: A Promising Therapeutic Approach to the Treatment of Severe Depressed Patients — Current Evidence and Intrinsic Mechanisms

  • Laura Perez-Caballero
  • Sonia Torres-Sanchez
  • Juan Antonio Mico
  • Esther Berrocoso
Chapter

Abstract

Major depressive disorder represents one of the most severe disabling disorders, affecting around 4.7% of the worldwide population. Many patients suffering this neuropsychiatric illness are treated successfully with various treatments, including antidepressant drugs and psychotherapy but also physical measures (electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagal nerve stimulation). Despite the different treatment approaches available, unfortunately 30–40% of the patients fail to respond to most first-line treatments, and between 5 and 10% do not respond to conventional therapy at all. Thus, a considerable number of patients have a poor outcome and unfortunately fail to reach sustained remission. These data highlight the need to find new therapeutic approaches that especially focus on refractory patients. In this context, deep brain stimulation (DBS) emerges as an innovative physical treatment for refractory depressed patients. DBS has been successfully used for years in some neurological disorders such as Parkinson’s disease. Currently, in addition to its use in treating depression, DBS is also being tested in other psychiatric illness such as obsessive–compulsive disorder. Most studies on DBS have focused on efficiency and efficacy, or improvement in the technique, and a few were devoted to understanding the intrinsic mechanisms responsible. Understanding the molecular mechanisms of action of DBS is currently considered as crucial, not only in order to understand its efficacy but also to propose new antidepressant approaches. The aim of this chapter is to review the foundations, the efficacy, and the efficiency of DBS in depression, and to provide insight into the intrinsic mechanisms of action described until now. In addition, future developments will be discussed.

Keywords

Deep brain stimulation Major depressive disorder Ventral capsule/ventral striatum Nucleus accumbens Subgenual cingulate cortex Lateral habenula Medial forebrain bundle Inferior thalamic peduncle 

Notes

Acknowledgements

This study was supported by grants from the “Instituto de Salud Carlos III (Madrid, Spain)”, co-financed by the “Fondo Europeo de Desarrollo Regional” (FEDER) (PI13/02659); the “Ministerio de Economía y Competitividad”, co-financed by FEDER (SAF2015-68647-R (MINECO/FEDER)); the “Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM”, Spain (G18); the “Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía”, Spain (CTS-510 and CTS-7748); 2015 NARSAD Young Investigator Grant from the Brain Behavior Research Foundation; and FPI (2011-145) fellowship. The authors declare no conflict of interest.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Laura Perez-Caballero
    • 1
  • Sonia Torres-Sanchez
    • 2
  • Juan Antonio Mico
    • 3
  • Esther Berrocoso
    • 1
  1. 1.Department of Psychology, Area of Psychobiology, Neuropsychopharmacology and Psychobiology Research GroupUniversity of Cádiz, CIBER for Mental Health (CIBERSAM), Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA)CádizSpain
  2. 2.Neuropsychopharmacology and Psychobiology Research GroupUniversity of Cádiz, CIBER for Mental Health (CIBERSAM), Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA)CádizSpain
  3. 3.Department of Neuroscience, Pharmacology and Psychiatry, Neuropsychopharmacology and Psychobiology Research GroupCIBER for Mental Health (CIBERSAM), Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA)CádizSpain

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