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. 2020 Aug 30;9(9):2796.
doi: 10.3390/jcm9092796.

Deep Brain Stimulation Is Effective for Treatment-Resistant Depression: A Meta-Analysis and Meta-Regression

Frederick L Hitti  1 , Andrew I Yang  1 , Mario A Cristancho  2 , Gordon H Baltuch  1
Affiliations

Deep Brain Stimulation Is Effective for Treatment-Resistant Depression: A Meta-Analysis and Meta-Regression

Frederick L Hitti et al. J Clin Med. .

Abstract

Major depressive disorder (MDD) is a leading cause of disability and a significant cause of mortality worldwide. Approximately 30-40% of patients fail to achieve clinical remission with available pharmacological treatments, a clinical course termed treatment-resistant depression (TRD). Numerous studies have investigated deep brain stimulation (DBS) as a therapy for TRD. We performed a meta-analysis to determine efficacy and a meta-regression to compare stimulation targets. We identified and screened 1397 studies. We included 125 citations in the qualitative review and considered 26 for quantitative analysis. Only blinded studies that compared active DBS to sham stimulation (k = 12) were included in the meta-analysis. The random-effects model supported the efficacy of DBS for TRD (standardized mean difference = -0.75, <0 favors active stimulation; p = 0.0001). The meta-regression did not demonstrate a statistically significant difference between stimulation targets (p = 0.45). While enthusiasm for DBS treatment of TRD has been tempered by recent randomized trials, this meta-analysis reveals a significant effect of DBS for the treatment of TRD. Additionally, the majority of trials have demonstrated the safety and efficacy of DBS for this indication. Further trials are required to determine the optimal stimulation parameters and patient populations for which DBS would be effective. Particular attention to factors including electrode placement technique, patient selection, and long-term follow-up is essential for future trial design.

Keywords: deep brain stimulation; depression; inferior thalamic peduncle; medial forebrain bundle; meta-analysis; meta-regression; subcallosal cingulate gyrus; treatment-resistant depression; ventral capsule; ventral striatum.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of studies selected for inclusion in the qualitative review and quantitative meta-analysis.
Figure 2
Figure 2
Meta-analysis forest plot depicting changes in HDRS/MADRS scores with active stimulation compared to sham stimulation. CI: confidence interval; IC: internal capsule; ITP: inferior thalamic peduncle; SMD: standardized mean difference; PI: prediction interval.
Figure 3
Figure 3
Meta-regression forest plot comparing various stimulation targets. CI: confidence interval; IC: internal capsule; ITP: inferior thalamic peduncle; MFB: medial forebrain bundle; SCC: subcallosal cingulate; SMD: standardized mean difference; TE: treatment effect; seTE: standard error of treatment effect.
Figure 4
Figure 4
Funnel plot of studies included in the quantitative analysis.
See this image and copyright information in PMC

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