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Review
. 2018 May;35(5):468-480.
doi: 10.1002/da.22746. Epub 2018 Apr 26.

A systematic review and meta-analysis of deep brain stimulation for depression

Steve Kisely  1   2   3   4 , Amy Li  1 , Nicola Warren  1   2 , Dan Siskind  1   2
Affiliations
Review

A systematic review and meta-analysis of deep brain stimulation for depression

Steve Kisely et al. Depress Anxiety. 2018 May.

Abstract

Background: Deep brain stimulation is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers.

Method: We performed a systematic review and meta-analysis on the effectiveness of deep brain stimulation (DBS) in depression. Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System, and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, crossover, and parallel-group trials in which DBS was compared with sham treatment using validated scales.

Results: Ten papers from nine studies met inclusion criteria, all but two of which were double-blinded RCTs. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 190 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (OR = 5.50; 95% CI = 2.79, 10.85; p < .0001) and reductions in mean depression score (SMD = -0.42; 95% CI = -0.72, -0.12; p = .006). However, the effect was attenuated on some of the subgroup and sensitivity analyses, and there were no differences for most other outcomes. In addition, 84 participants experienced a total of 131 serious adverse effects, although not all could be directly associated with the device or surgery. Finally, publication bias was possible.

Conclusions: DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.

Keywords: brain stimulation/TMS/DBS/VNS; clinical trials; depression; mood disorders; systematic review; treatment.

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