A systematic review of psychiatric indications for deep brain stimulation, with focus on major depressive and obsessive-compulsive disorder

Abstract

Background: Deep brain stimulation is a treatment under investigation for a range of psychiatric disorders. It has shown promising results for therapy-refractory obsessive–compulsive disorder (OCD) and major depressive disorder (MDD). Other indications under investigation include Tourette’s syndrome, anorexia nervosa and substance use disorders. Aims: To review current studies on psychiatric indications for deep brain stimulation (DBS), with focus on OCD and MDD. Method: A systematic search was carried out in MEDLINE, and the literature was searched to identify studies with DBS for psychiatric disorders. The identified studies were analysed based on patient characteristics, treatment results and adverse effects of DBS. Results: A total of 52 papers met the inclusion criteria and described a total of 286 unique patients treated with DBS for psychiatric indications; 18 studies described 112 patients treated with DBS for OCD in six different anatomical targets, while nine studies presented 100 patients with DBS for MDD in five different targets. Conclusion: DBS may show promise for treatment-resistant OCD and MDD but the results are limited by small sample size and insufficient randomized controlled data. Deep brain stimulation for OCD has received United States Food and Drug Administration approval. Other psychiatric indications are currently of a purely experimental nature.