2nd European Conference on Schizophrenia Research: From Research to Practice |
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Authors: | Georg Juckel Idun Uhl Frank Padberg Martin Brüne Christine Winter |
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Institution: | (1) Department of Psychiatry Psychotherapy and Psychosomatic Medicine, Ruhr-University, Alexandrinenstr. 1, Bochum, 44791, Germany;(2) Department of Psychiatry, Ludwig-Maximilian-University, Munich, Germany;(3) Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Mitte, Berlin, Germany |
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Abstract: | For decades, the most severe, protracted and therapy-resistant forms of major depression have compelled clinicians and researchers
to look for last resort treatment. Early psychosurgical procedures were hazardous and often associated with severe and persistent
side effects including avolition, apathy and change of personality. With the introduction of psychopharmacological treatments
in the 1950s, the frequency of ablative procedures declined rapidly. The past decade, however, has witnessed the resurgence
of surgical strategies as a result of refined techniques and advances such as high frequency stimulation of deep brain nuclei.
Recent data suggest that the overall effect of high frequency stimulation lies in the functional inhibition of neural activity
in the region stimulated. Contrary to other psychosurgical procedures, high frequency stimulation reversibly modulates targeted
brain areas and allows a postsurgical adaption of the stimulation parameters according to clinical outcome. With increased
understanding of the brain regions and functional circuits involved in the pathogenesis of psychiatric disorders, major depression
has emerged as a target for new psychosurgical approaches to selectively and precisely modulate neural areas involved in the
disease process. Recent studies of minimally intervening procedures report good clinical outcome in the treatment of therapy-resistant
forms of major depression. High frequency stimulation was successfully applied in several small samples of patients with treatment-resistant
depression when the stimulation focused on different areas, e.g., nucleus accumbens, the lateral habenula or cortical areas.
Nevertheless, the reticence toward psychosurgery, even for those patients suffering from the most debilitating forms of depression,
still prevails, even though recent studies have shown significant improvement in terms of quality of life with the limitation
that the number of treated cases has been small. In any event, valid and unambiguous criteria for patient eligibility have
yet to be refined and standardized. In this review, we suggest possible standard criteria for the application of deep brain
stimulation on patients suffering from otherwise treatment-resistant depression. |
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Keywords: | depression psychosurgery deep brain stimulation DBS |
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