Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-28T17:45:39.139Z Has data issue: false hasContentIssue false

28 - Efficacy of brain stimulation and neurosurgical procedures for treatment of mood disorders

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
Kunal K. Patra  and
Edward Coffey
Edited by
Peter Tyrer  and
Kenneth R. Silk
Kunal K. Patra
Affiliation:
Department of Psychiatry Henry Ford Health System Detroit, MI USA
Edward Coffey
Affiliation:
Department of Psychiatry Henry Ford Health System Detroit, MI USA
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
Get access

Summary

Editor's note

This chapter should be looked at in conjunction with Chapter 4, where additional justification is given for the rationale behind the newer of these therapies.

In this chapter we review the efficacy of contemporary procedures used in the treatment of mood disorders, including brain stimulation (electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagal nerve stimulation (VNS)) and neurosurgical interventions. We focus our review on methodologically sound randomized controlled trials (RCTs), i.e. a prospective comparison of the procedure to either placebo (sham treatment) or an alternative therapy, with random assignment of consecutive patients (rigorously diagnosed) to the treatment groups, and with blinded objective assessment of outcome using sound statistical analyses.

Brain stimulation procedures

Electroconvulsive therapy (ECT)

In ECT, a brief electrical stimulus is applied through the scalp of a patient under general anesthesia, with the goal of inducing a generalized cerebral seizure. Electroconvulsive therapy is a safe medical procedure due in large part to several important medical modifications in the procedure (use of oxygen, anticholinergic premedication where indicated, anesthesia, and muscle relaxation), and recent improvements in technique (e.g., brief pulse stimulus waveform, appropriate stimulus dosage, appropriate stimulus electrode placement, and quantitative seizure monitoring), all of which have lessened cognitive side effects and improved efficacy. Since its inception in 1938, the efficacy of ECT in mood disorders has been documented by an extensive clinical experience and by numerous open and comparative trials (APA, 2001; Abrams, 2002).

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 498 - 506
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrams, R. (2002). Electroconvulsive Therapy, 4th edn. New York: Oxford University Press.
American Psychiatric Association (APA) (2000). Practice Guideline for the Treatment of Patients with Major Depressive Disorder (Revision). American Journal of Psychiatry, 157 (April Suppl.) [G]
American Psychiatric Association (APA). (2001). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, 2nd edn. Washington DC: American Psychiatric Association.
American Psychiatric Association (APA). (2002). Practice Guideline for the Treatment of Patients with Bipolar Disorder (Revision). American Journal of Psychiatry, 159 (April Suppl. 4).
Anderson, I. M., Delvai, N. A., Ashim, B. S.et al. (2007). Adjunctive fast repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. British Journal of Psychiatry, 190, 533–4.Google Scholar
Berman, R. M., Narasimhan, M., Sanacora, G.et al. (2000). A randomize clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biological Psychiatry, 47(4), 332–37.Google Scholar
Binder, D. K. & Iskandar, B. J. (2000). Modern neurosurgery for psychiatric disorders. Neurosurgery, 47(1), 9–23.Google Scholar
Brandon, S., Cowley, P., McDonald, C.et al. (1984). Electroconvulsive therapy: results in depressive illness from the Leicestershire trial. British Medical Journal, 288, 22–5.Google Scholar
Burt, T., Lisanby, S. H. & Sackeim, H. A. (2002). Neuropsychiatric applications of transcranial magnetic stimulation. International Journal of Neuropsychopharmacology, 5, 73–103.Google Scholar
Cosgrove, G. R. (2000). Surgery for psychiatric disorders. CNS Spectrums, 5(10), 43–52.Google Scholar
Daskalakis, Z. J., Christensen, B. K., Fitzgerald, P. B. & Chen, R. (2002). Transcranial magnetic stimulation: a new investigational and treatment tool in psychiatry. Journal of Neuropsychiatry and Clinical Neuroscience, 14, 406–15.Google Scholar
Davis, J. M., Wang, Z. & Janicak, P. G. (1993). A quantitative analysis of clinical drug trials for the treatment of affective disorders. Psychopharmacology Bulletin, 29, 175–81.Google Scholar
Dinan, T. G. & Barry, S. (1989). A comparison of electroconvulsive therapy with a combined lithium and tricyclic combination among depressed nonresponders. Acta Psychiatria Scandinavica, 80, 97–100.Google Scholar
Elger, G., Hoppe, C., Falkai, P.et al. (2000). Vagus nerve stimulation is associated with mood improvements in epilepsy patients. Epilepsy Research, 42(2–3), 203–10.Google Scholar
Expert Consensus Guideline (2001a). Treatment of depression in women. Postgraduate Medicine.
Expert Consensus Guideline Series (2001b). Pharmacotherapy of depressive disorders in older patients. Postgraduate Medicine.
Folkerts, H. W., Michael, N., Tolle, R.et al. (1997). Electroconvulsive therapy vs. paroxetine in treatment-resistant depression – a randomized study. Acta Psychiatrica Scandinavica, 96, 334–42.Google Scholar
Freeman, C. P. L., Basson, J. V. & Crighton, A. (1978). Double-blind controlled trial of electroconvulsive therapy (E.C.T.) and simulated E.C.T. in depressive illness. The Lancet, 1, 738–40.Google Scholar
Gangadhar, B. N., Kpaur, R. L. & Kalyanasundaram, S. (1982). Comparison of electroconvulsive therapy with imipramine in endogenous depression: a double blind study. British Journal of Psychology, 141, 367–71.Google Scholar
Garcia-Toro, M., Mayol, A., Arnillas, H.et al. (2001). Modest adjunctive benefit with transcranial magnetic stimulation in medication resistant depression. Journal of Affective Disorders, 64(2–3), 271–5.Google Scholar
George, M. S., Wassermann, E. M., Williams, W. E.et al. (1997). Mood improvements following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. American Journal of Psychiatry, 154, 1752–6.Google Scholar
George, M. S., Lisanby, S. H. & Sackeim, H. A. (1999). Transcranial Magnetic Stimulation: applications in neuropsychiatry. Archives of Genernal Psychiatry, 56, 300–11.Google Scholar
George, M. S., Nahas, Z., Molloy, M.et al. (2000). A controlled trial of daily prefrontal cortex TMS for treating depression. Biological Psychiatry, 48(10), 962–70.Google Scholar
George, M. S., Nahas, Z., Bohning, D.et al. (2002). Vagus nerve stimulation therapy: a research update. Neurology, 59 (Suppl. 4), S56–S61.Google Scholar
George, M. S., Nahas, Z., Kozel, F. A.et al. (2003). Mechanisms and the current state of transcranial magnetic stimulation. CNS Spectrums, 8(7), 496–514.Google Scholar
George, M. S., Rush, A. J., Marangell, L. B.et al. (2005). A one year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression. Biological Psychiatry, 58(5), 364–73.Google Scholar
Gershon, A. A., Dannon, P. N. & Grunhaus, L. (2003). Transcranial Magnetic Stimulation in the treatment of depression. American Journal of Psychiatry, 160(5), 835–45.Google Scholar
Greenberg, B. D. & Rezai, A. R. (2003). Mechanisms and the current state of deep brain stimulation in neuropsychiatry. CNS Spectrums, 8(7), 522–6.Google Scholar
Greenblatt, M., Grosser, G. H. & Wechsler, H. (1964). Differential response of hospitalized depressed patients to somatic therapy. American Journal of Psychology, 120, 935–43.Google Scholar
Gregory, S., Shawcross, C. R. & Gill, D. (1985). The Nottingham ECT Study. A double-blind comparison of bilateral, unilateral and simulated ECT in depressive illness. British Journal of Psychiatry, 146, 520–4.Google Scholar
Harden, C. L., Pulver, M. C., Ravdin, L. D.et al. (2000). A pilot study of mood in epilepsy patients treated with vagus nerve stimulation. Epilepsy Behavior, 1(2), 93–9.Google Scholar
Holtzheimer, P. E., Russo, J. & Avery, D. (2001). A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression. Psychopharmacology Bulletin, 35, 149–69.Google Scholar
Johnstone, E. C., Deakin, J. F. W., Lawler, P.et al. (1980). The Northwick Park electroconvulsive therapy trial. The Lancet, 2, 1317–20.Google Scholar
Kho, K. H., Vreeswijk, M. F., Simpson, S. & Zwinderman, A. H. (2003). A meta-analysis of electroconvulsive therapy efficacy in depression. Journal of ECT, 19(3), 139–47.Google Scholar
Kozel, F. A. & George, M. S. (2002). Meta-analysis of left prefrontal repetitive transcranial magnetic stimulation to treat depression. Journal of Psychiatric Practice, 8, 270–5.Google Scholar
Kosel, M. & Schlaepfer, T. E. (2003). Beyond the treatment of epilepsy: new applications of vagus nerve stimulation in psychiatry. CNS Spectrums, 8(7), 515–21.Google Scholar
Lambourn, J. & Gill, D. (1978). A controlled comparison of simulated and real ECT. British Journal of Psychiatry, 133, 514–19.Google Scholar
McNamara, B., Ray, J. L., Arthurs, O. J.et al. (2001). Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychological Medicine, 31, 1141–6.Google Scholar
Mallet, L., Mesnage, V.et al. (2002). Compulsions, Parkinson's disease, and stimulation. Lancet, 360, 1302–4.Google Scholar
Marangell, L. B., Rush, A. J., George, M. S.et al. (2005). Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biological Psychiatry, 51(4), 280–7.Google Scholar
Martin, J. L. R., Barbanoj, M. J., Schlaepfer, T. E.et al. (2003). Repetitive transcranial magnetic stimulation for the treatment of depression: systematic review and meta-analysis. British Journal of Psychiatry, 182, 480–91.Google Scholar
Martin, J. L. R., Barbanoj, M. J., Schlaepfer, T. E.et al. (2004). Transcranial magnetic stimulation for treating depression [Review]. The Cochrane Database of Systematic Reviews, 1. Oxford: Update Software Ltd.Google Scholar
Mayberg, H. S., Lozano, A. M., Voon, V.et al. (2005). Deep brain stimulation for treatment-resistant depression. Neuron, 45, 651–60.Google Scholar
Medical Research Council (1965). Clinical trial of the treatment of depressive illness. British Medical Journal, 5439, 881–6.
Mukherjee, S., Sackeim, H. A. & Schnur, D. B. (1994). Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience. American Journal of Psychiatry, 151, 169–76.Google Scholar
Nahas, Z., Oliver, N. C., Johnson, M.et al. (2000). Feasibility and efficacy of left prefrontal rTMS as a maintenance antidepressant [abstract]. Biological Psychiatry, 57.Google Scholar
Nahas, Z., Marangell, L. B., Husain, M. M.et al. (2005). Two year outcome of vagus nerve stimulation (VNS) for treatment of major depressive episodes. Journal of Clinical Psychiatry, 66(9), 1097–104.Google Scholar
National Institute for Clinical Excellence (NICE) Report (April 2003). www.nice.org.uk/pdf/Final_assessment_reportECT.pdf.
Nuttin, B., Cosyns, P.et al. (1999). Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet, 354, 1526.Google Scholar
Ovsiew, F. & Frim, D. M. (1997). Neurosurgery for psychiatric disorders. Journal of Neurology, Neurosurgery and Psychiatry, 63, 701–5.Google Scholar
Pollak, P., Fraix, V., Krack, P.et al. (2002). Treatment results: Parkinson's disease. Movement Disorders, 17(Suppl. 3), S75–S83.Google Scholar
Rifkin, A. (1988). ECT versus tricylic antidepressants in depression: a review of the evidence. Journal of Clinical Psychiatry, 49, 3–7.Google Scholar
Rush, A. J., Rago, W. V., Crismon, M. L.et al. (1999). Medication treatment for the severely and persistently mentally ill: the Texas medication algorithm project. Journal of Clinical Psychiatry, 60(5), 284–91.Google Scholar
Rush, A. J., George, M. S., Sackeim, H. A.et al. (2000). Vagus nerve stimulation (VNS) for treatment-resistant depression: a multicenter study. Biological Psychiatry, 47, 276–86.Google Scholar
Rush, A. J., Linden, M. & Zobel, A. (2002). Vagus stimulation. Eine Neue Behaldlungsoption fur chronifizierte depressive Erkrankungen. Fortschrift Neurologie Psychiatrie, 70, 297–302.Google Scholar
Rush, A. J., Marangell, L. B., Sackeim, H. A.et al. (2005a) Vagus nerve stimulation for treatment-resistant depression: a randomized, controlled acute-phase trial. Biological Psychiatry, 58(5), 347–54.Google Scholar
Rush, A. J., Sackeim, H. A., Marangell, L. B.et al. (2005b). Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biological Psychiatry, 58, 355–63.Google Scholar
Sackeim, H. A., Rush, A. J., George, M. S.et al. (2001). Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology, 25(5), 713–28.Google Scholar
Sikdar, S., Kulhara, P., Avasthi, A. & Singh, H. (1994). Combined chlorpromazine and electroconvulsive therapy in mania. British Journal of Psychology, 164, 806–10.Google Scholar
Small, J. G., Klapper, M. H., Kellams, J. J.et al. (1988). Electroconvulsive treatment compared with lithium in the management of manic states. Archives in General Psychology, 45, 727–32.Google Scholar
The Expert Consensus Guideline Series (1996). Treatment of bipolar disorder. Journal of Clinical Psychiatry, 57(12A), 11–88.
UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. The Lancet, 361, 799–808.
US Army MEDCOM Report. http://www.cs.amedd.army.mil/qmo/depress/depress.htm.
US Senate Committee on Finance (2006). Review of the FDA's approval process for the vagus nerve stimulation therapy system for treatment resistant depression. February 2006. Available at: http://finance.senate.gov/press/Gpress/02report.pdf.
West, E. D. (1981). Electric convulsion therapy in depression: a double-blind controlled trial. British Medical Journal, 282, 355–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×