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Separating Hope from Hype: Some Ethical Implications of the Development of Deep Brain Stimulation in Psychiatric Research and Treatment

Published online by Cambridge University Press:  07 November 2014

Thomas E. Schlaepfer ,
S.H. Lisanby  and
Stefano Pallanti
Thomas E. Schlaepfer
Affiliation:
University of Bonn
S.H. Lisanby
Affiliation:
Columbia University
Stefano Pallanti
Affiliation:
Moun Sinai School of Medicine
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Extract

Major depression is the most common serious brain disorder with a lifetime prevalence of up to 17%. Despite numerous options currently available for the treatment of depression, ~2 million people in the United States may experience an inadequate response to treatment (treatment-resistant depression [TRD]) at some point in their lives. The definition of TRD is variable, ranging from a failure to respond to two or more trials of antidepressant monotherapy to a failure to respond to four or more trials of different antidepressant therapies, including augmentation, combination therapy, and electroconvulsive therapy. It has been reported that as many as one-third of patients experience only a partial response to initial therapy, while nearly one-fifth are considered nonresponders. In addition to the obvious quality of life issues for the patient with TRD, the economic cost of TRD is significant. Annual healthcare costs increase significantly for patients with TRD with each successive change in antidepressant medication. Early in treatment (two medication changes), the annual costs are <$7,000/Year. By the eighth medication change, annual costs double to nearly $14,000/year.

There is a well-documented need for better long-term treatments for TRD, as witnessed by multiple efforts to establish treatment algorithms and best treatment steps when first and subsequent treatment measures prove inadequate. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which analyzed outcome following several standardized antidepressive treatment steps, reported that 33% of patients did not respond even after four evidence-based treatment steps. A substantial proportion of patients are inadequately treated and some of these will go on to suffer from chronic, debilitating, and life-threatening symptoms.

Type
Brain Stimulation
Information
CNS Spectrums , Volume 15 , Issue 5 , May 2010 , pp. 285 - 287
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1.Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-ef-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.CrossRefGoogle ScholarPubMed
2.Nierenberg, AA, Papakostas, GI, Petersen, T, et al.Lithium augmentation of nortriptyline for subjects resistant to multiple antidepressants. J Clin Psychopharmacol. 2003;23:92–95.CrossRefGoogle ScholarPubMed
3.Philip, NS, Carpenter, LL, Tyrka, AR, Price, LH. Pharmacologic approaches to treatment resistant depression: a re-examination for the modern era. Expert Opin Pharmacother. 2010;11:709–722.CrossRefGoogle ScholarPubMed
4.Fava, M, Davidson, KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am. 1996;19:179–200.CrossRefGoogle ScholarPubMed
5.Russell, JM, Hawkins, K, Ozminkowski, RJ, et al.The cost consequences of treatment-resistant depression. J Clin Psychiatry. 2004;65:341–347.CrossRefGoogle ScholarPubMed
6.Rush, AJ, Sackeim, HA, Marangell, LB, et al.Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005:50:355–363.CrossRefGoogle Scholar
7.Rush, AJ, Trivedi, MH, Wisniewski, SR, et al.Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905–1917.CrossRefGoogle ScholarPubMed
8.Holtzheimer, PE, Nemeroff, CB. Novel targets for antidepressant therapies. Curr Psychiatry Rep. 2008;10:465–473.CrossRefGoogle ScholarPubMed
9.Schlaepfer, TE, George, MS, Mayberg, H. WFSBP Guidelines on Brain Stimulation Treatments in Psychiatry. World J Biol Psychiatry. 2009:1–17.CrossRefGoogle Scholar
10.Schlapfer, TE, Bewernick, BH. Deep brain stimulation for psychiatric disorders--state of the art. Adv Tech Stand Neurosurg. 2009;34:37–57.CrossRefGoogle ScholarPubMed
11.Mallet, L, Polosan, M, Jaafari, N, et al.Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359:2121–2134.CrossRefGoogle ScholarPubMed
12.Abelson, JL, Curtis, GC, Sagher, O, et al.Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry. 2005;57:510–516.CrossRefGoogle ScholarPubMed
13.Greenberg, BD, Malone, DA, Friehs, GM, et al.Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006;31:2394.CrossRefGoogle ScholarPubMed
14.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. 2009;67:110–116.CrossRefGoogle Scholar
15.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;64:461–467.CrossRefGoogle ScholarPubMed
16.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;65:267–275.CrossRefGoogle ScholarPubMed
17.Goodman, WK, Insel, TR. Deep brain stimulation in psychiatry: concentrating on the road ahead. Biol Psychiatry. 2009;65:263–266.CrossRefGoogle ScholarPubMed
18. Advanced Neuromodulation Systems (ANS) Inc. BROADEN Clinical Study. A Study of a Non-Pharmacological Device for Depression. 2007; http://www.broadenstudy.com/sb/index.html. Accessed: January 6,2009.Google Scholar
19. Medtronic Inc. Medtronic to Pursue Major Clinical Trial of Deep Brain Stimulation as Depression Treatment. 2006; http://findarticles.com/p/articles/mi_mOEIN/is_2006_April_25/ai_n26838044?tag=content-inner;col1. Accessed: January 6,2009.Google Scholar
20.Glannon, W. Stimulating brains, altering minds. J Med Ethics. 2009;35:289–292.CrossRefGoogle ScholarPubMed
21.Rabins, P, Appleby, B, Brandt, J, et al.Scientific and Ethical Issues Related to Deep Brain Stimulation for Disorders of Mood, Behavior and Thought. Arch Gen Psychiatry. 2009;66:931–937.CrossRefGoogle ScholarPubMed
22.Kringelbach, ML, Aziz, TZ. Deep brain stimulation: avoiding the errors of psychosurgery. JAMA. 2009;301:1705–1707.CrossRefGoogle ScholarPubMed
23.Miller, G. Neuropsychiatry. Rewiring faulty circuits in the brain. Science. 2009;323:1554–1556.CrossRefGoogle ScholarPubMed
24.Hildt, E. Electrodes in the brain: Some anthropological and ethical aspects of deep brain stimulation. International Review of Information Ethics. 2006;5:33–39.CrossRefGoogle Scholar
25.Synofzyk, M, Schlaepfer, TE. Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. J Biotechnol. 2008;3:1511–1520.CrossRefGoogle Scholar
26.Hamani, C, McAndrews, MP, Cohn, M, et al.Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Ann Neurol. 2008;63:119–123.CrossRefGoogle ScholarPubMed
27.Sani, S, Jobe, K, Smith, A, Kordower, JH, Bakay, RA. Deep brain stimulation for treatment of obesity in rats. J Neurosurg. 2007;107:809–813.CrossRefGoogle ScholarPubMed
28.Kuhn, J, Lenartz, D, Huff, W, et al.Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications? J Neurol Neurosurg Psychiatry. 2007;78:1152–1153.CrossRefGoogle ScholarPubMed
29.Franzini, A, Marras, C, Ferrali, P, Bugiani, O, Broggi, G. Stimulation of the posterior hypothalamus for medically intractable impulsive and violent behavior. Stereotact Funct Neurosurg. 2005;83:63–66.CrossRefGoogle ScholarPubMed
30.Kuhn, J, Lenartz, D, Mai, JK, Huff, W, Klosterkoetter, J, Sturm, V. Disappearance of self-aggressive behavior in a brain-injured patient after deep brain stimulation of the hypothalamus: technical case report. Neurosurgery. 2008;62:E1182.Google Scholar
31.Schlaepfer, TE, Fins, JJ. Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough. JAMA. 2010;303:775–776.CrossRefGoogle ScholarPubMed
32.Schupbach, M, Gargiulo, M, Welter, ML, et al.Neurosurgery in Parkinson disease: a distressed mind in a repaired body? Neurology. 2006;66:1811–1816.CrossRefGoogle Scholar
33.Racine, E, Waldman, S, Palmour, N, Risse, D, liles, J. “Currents of hope”: neurostimulation techniques in U.S. and U.K. print media. Camb Q Healthc Ethics. 2007;16:312–316.CrossRefGoogle ScholarPubMed