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Deep brain stimulation for bipolar disorder—review and outlook

Published online by Cambridge University Press:  10 February 2016

Sabrina M. Gippert ,
Christina Switala ,
Bettina H. Bewernick ,
Sarah Kayser ,
Alena Bräuer ,
Volker A. Coenen  and
Thomas E. Schlaepfer
Sabrina M. Gippert
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany
Christina Switala
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany
Bettina H. Bewernick
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany
Sarah Kayser
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany
Alena Bräuer
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany
Volker A. Coenen
Affiliation:
Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
Thomas E. Schlaepfer*
Affiliation:
Department of Psychiatry and Psychotherapy University Hospital, Bonn, Germany Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland, USA
*
*Address for correspondence: Thomas E. Schlaepfer, MD, Department of Psychiatry and Psychotherapy, University Hospital, Sigmund-Freud-Straße 25, 53105 Bonn, Germany. (Email: schlaepf@jhmi.edu)
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Abstract

Research on deep brain stimulation (DBS) for treatment-resistant psychiatric disorders has established preliminary efficacy signals for treatment-resistant depression. There are only few studies on DBS that included patients suffering from bipolar disorder. This article gives an overview of these studies concerning DBS targets, antidepressant efficacy, and the occurrence of manic/hypomanic symptoms under stimulation. First, promising results show that all patients experienced significant improvement in depressive symptomatology. In a single case, hypomanic symptoms occurred, but they could be resolved by adjusting stimulation parameters. Furthermore, this article highlights important clinical differences between unipolar and bipolar depression that have to be considered throughout the course of treatment.

Keywords

Bipolar disorderdeep brain stimulationmedial forebrain bundleslMFBtreatment-resistant depression
Type
Review Articles
Information
CNS Spectrums , Volume 22 , Issue 3 , June 2017 , pp. 254 - 257
Copyright
© Cambridge University Press 2016 

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Footnotes

This investigator-initiated trial was funded using university funds; additionally, limited support from Medtronic Inc. was obtained; the protocol is registered at Clinical-Trials.gov with the identifier NCT01095263.

References

1. Mallet, L, Mesnage, V, Houeto, JL, et al. Compulsions, Parkinson’s disease, and stimulation. Lancet. 2002; 360(9342): 1302–1304.CrossRefGoogle ScholarPubMed
2. Greenberg, BD, Price, LH, Rauch, SL, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am. 2003; 14(2): 199–212.CrossRefGoogle ScholarPubMed
3. Price, BH, Baral, I, Cosgrove, GR, et al. Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases. J Clin Psychiatry. 2001; 62(12): 925–932.CrossRefGoogle ScholarPubMed
4. Schläpfer, TE, Bewernick, BH. Deep brain stimulation for psychiatric disorders—state of the art. Adv Tech Stand Neurosurg. 2009; 34: 37–57.CrossRefGoogle ScholarPubMed
5. Schlaepfer, TE, Bewernick, BH, Kayser, S, Hurlemann, R, Coenen, VA. Deep brain stimulation of the human reward system for major depression—rationale, outcomes, and outlook. Neuropsychopharmacology. 2014; 39(6): 1303–1314.CrossRefGoogle ScholarPubMed
6. Angst, J, Sellaro, R, Stassen, HH, Gamma, A. Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. J Affect Disord. 2005; 84(2–3): 149–157.CrossRefGoogle ScholarPubMed
7. Belmaker, RH. Bipolar disorder. N Engl J Med. 2004; 351(5): 476–486.CrossRefGoogle ScholarPubMed
8. Hegerl, U, Bottner, AC, Holtschmidt-Täschner, B, et al. Onset of depressive episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a retrospective comparative study. J Clin Psychiatry. 2008; 69(7): 1075–1080.CrossRefGoogle ScholarPubMed
9. Gassab, L, Mechri, A, Gaha, L, Khiari, G, Zaafrane, F, Zougaghi, L. [Bipolarity correlated factors in major depression: about 155 Tunisian inpatients]. Encephale. 2002; 28(4): 283–289.Google ScholarPubMed
10. Abrams, R, Taylor, MA. A comparison of unipolar and bipolar depressive illness. Am J Psychiatry. 1980; 137(9): 1084–1087.Google ScholarPubMed
11. Mitchell, PB, Wilhelm, K, Parker, G, Austin, MP, Rutgers, P, Malhi, GS. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry. 2001; 62(3): 212–216; quiz 7.CrossRefGoogle ScholarPubMed
12. Angst, J, Preisig, M. Course of a clinical cohort of unipolar, bipolar and schizoaffective patients: results of a prospective study from 1959 to 1985. Schweiz Arch Neurol Psychiatr. 1995; 146(1): 5–16.Google ScholarPubMed
13. Furukawa, TA, Konno, W, Morinobu, S, Harai, H, Kitamura, T, Takahashi, K. Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression. Psychiatry Res. 2000; 96(3): 211–220.CrossRefGoogle ScholarPubMed
14. Winokur, G, Coryell, W, Keller, M, Endicott, J, Akiskal, H. A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Arch Gen Psychiatry. 1993; 50(6): 457–465.CrossRefGoogle ScholarPubMed
15. Coryell, W, Keller, M, Endicott, J, Andreasen, N, Clayton, P, Hirschfeld, R. Bipolar II illness: course and outcome over a five-year period. Psychol Med. 1989; 19(1): 129–141.CrossRefGoogle ScholarPubMed
16. Berns, GS, Nemeroff, CB. The neurobiology of bipolar disorder. Am J Med Genet C Semin Med Genet. 2003; 123(1): 76–84.CrossRefGoogle Scholar
17. Mitchell, PB, Frankland, A, Hadzi-Pavlovic, D, et al. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. Br J Psychiatry. 2011; 199(4): 303–309.CrossRefGoogle ScholarPubMed
18. Cuellar, AK, Johnson, SL, Winters, R. Distinctions between bipolar and unipolar depression. Clin Psychol Rev. 2005; 25(3): 307–339.CrossRefGoogle ScholarPubMed
19. Kupferschmidt, DA, Zakzanis, KK. Toward a functional neuroanatomical signature of bipolar disorder: quantitative evidence from the neuroimaging literature. Psychiatry Res. 2011; 193(2): 71–79.CrossRefGoogle Scholar
20. Marchand, WR, Yurgelun-Todd, D. Striatal structure and function in mood disorders: a comprehensive review. Bipolar Disord. 2010; 12(8): 764–785.CrossRefGoogle ScholarPubMed
21. Gijsman, HJ, Geddes, JR, Rendell, JM, Nolen, WA, Goodwin, GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry. 2004; 161(9): 1537–1547.CrossRefGoogle ScholarPubMed
22. Papadimitriou, GN, Dikeos, DG, Soldatos, CR, Calabrese, JR. Non-pharmacological treatments in the management of rapid cycling bipolar disorder. J Affect Disord. 2007; 98(1–2): 1–10.CrossRefGoogle ScholarPubMed
23. Gitlin, M. Treatment-resistant bipolar disorder. Mol Psychiatry. 2006; 11(3): 227–240.CrossRefGoogle ScholarPubMed
24. Nemeroff, CB. Use of atypical antipsychotics in refractory depression and anxiety. J Clin Psychiatry. 2005; 66(Suppl 8): 13–21.Google ScholarPubMed
25. Forty, L, Smith, D, Jones, L, et al. Clinical differences between bipolar and unipolar depression. Br J Psychiatry. 2008; 192(5): 388–389.CrossRefGoogle ScholarPubMed
26. Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133(5): 429–435.CrossRefGoogle ScholarPubMed
27. Bewernick, B, Hurlemann, R, Matusch, A, et al. Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol Psychiatry. 2010; 67(2): 110–116.CrossRefGoogle ScholarPubMed
28. Schlaepfer, TE, Cohen, MX, Frick, C, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2007; 33(2): 368–377.CrossRefGoogle ScholarPubMed
29. Lozano, AM, Mayberg, HS, Giacobbe, P, Hamani, C, Craddock, RC, Kennedy, SH. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry. 2008; 64(6): 461–467.CrossRefGoogle ScholarPubMed
30. Mayberg, H, Lozano, A, Voon, V, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005; 45(5): 651–660.CrossRefGoogle ScholarPubMed
31. Puigdemont, D, Perez-Egea, R, Portella, MJ, et al. Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression. Int J Neuropsychopharmacol. 2011; 15(1): 121–133.CrossRefGoogle ScholarPubMed
32. Malone, DA Jr, Dougherty, DD, Rezai, AR, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009; 65(4): 267–275.CrossRefGoogle ScholarPubMed
33. Coenen, VA, Panksepp, J, Hurwitz, TA, Urbach, H, Madler, B. Human medial forebrain bundle (MFB) and anterior thalamic radiation (ATR): imaging of two major subcortical pathways and the dynamic balance of opposite affects in understanding depression. J Neuropsychiatry Clin Neurosci. 2012; 24(2): 223–236.CrossRefGoogle ScholarPubMed
34. Nestler, EJ, Carlezon, WA Jr. The mesolimbic dopamine reward circuit in depression. Biol Psychiatry. 2006; 59(12): 1151–1159.CrossRefGoogle ScholarPubMed
35. Coenen, VA, Schlaepfer, TE, Maedler, B, Panksepp, J. Cross-species affective functions of the medial forebrain bundle-Implications for the treatment of affective pain and depression in humans. Neurosci Biobehav Rev. 2011; 35(9): 1971–1981.CrossRefGoogle ScholarPubMed
36. Holtzheimer, PE, Kelley, ME, Gross, RE, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry. 2012; 69(2): 150–158.CrossRefGoogle ScholarPubMed
37. Haq, IU, Foote, KD, Goodman, WK, et al. A case of mania following deep brain stimulation for obsessive compulsive disorder. Stereotact Funct Neurosurg. 2010; 88(5): 322–328.CrossRefGoogle ScholarPubMed
38. Coenen, VA, Schlaepfer, TE, Maedler, B, Panksepp, J. Cross-species affective functions of the medial forebrain bundle—implications for the treatment of affective pain and depression in humans. Neurosci Biobehav Rev. 2011; 35(9): 1971–1981.CrossRefGoogle ScholarPubMed
39. Schoene-Bake, JC, Parpaley, Y, Weber, B, Panksepp, J, Hurwitz, TA, Coenen, VA. Tractographic analysis of historical lesion surgery for depression. Neuropsychopharmacology. 2010; 35(13): 2553–2563.CrossRefGoogle ScholarPubMed
40. Schlaepfer, TE, Bewernick, B, Kayser, S, Mädler, B, Coenen, V. Rapid effects of deep brain stimulation for treatment resistant major depression. Biol Psychiatry. 2013; 73(12): 1204–1212.CrossRefGoogle ScholarPubMed