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. 2021 Apr 1:15:655412.
doi: 10.3389/fnins.2021.655412. eCollection 2021.

Deep Brain Stimulation in Treatment-Resistant Depression: A Systematic Review and Meta-Analysis on Efficacy and Safety

Youliang Wu  1 , Jiajie Mo  2   3 , Lisen Sui  1 , Jianguo Zhang  2   3 , Wenhan Hu  2   3 , Chao Zhang  2   3 , Yao Wang  2   3 , Chang Liu  2   3 , Baotian Zhao  2   3 , Xiu Wang  2   3 , Kai Zhang  2   3 , Xuemin Xie  1
Affiliations

Deep Brain Stimulation in Treatment-Resistant Depression: A Systematic Review and Meta-Analysis on Efficacy and Safety

Youliang Wu et al. Front Neurosci. .

Abstract

Objective: Deep brain stimulation (DBS) has shown promising outcomes as new therapeutic opportunities for patients with treatment-resistant depression (TRD) who do not respond adequately to several consecutive treatments. This study aims to systematically review and conduct a meta-analysis on the efficacy and safety of DBS for TRD. Method: The literature was comprehensively reviewed using Medline, Google scholar, Cochrane library, Embase, and World Health Organization International Clinical Trials Registry Platform until January 2019. The studied outcomes included response, remission, recurrence, and adverse events (AEs) rates, and were reported as the rate ratio (RR) or pooled estimate with a 95% confidence interval (95% CI). Heterogeneity was measured by an I-square test and a sensitive analysis. Results: A total of 17 studies involving 7 DBS targets were included. For efficacy, DBS treatment was statistically beneficial for TRD, and the response, remission, and recurrence rates were 56% (ranging from 43 to 69%), 35% (ranging from 27 to 44%), and 14% (ranging from 4 to 25%), respectively. However, only two randomized-controlled trials (RCTs) considered the invalidity of DBS (RR = 1.45, 95% CI = 0.50-4.21). For safety, the AEs rate was 67% (ranging from 54 to 80%). The AEs were common and moderate, but the problems related to suicide and suicidal ideation should not be underestimated. Conclusion: These findings suggest that DBS for TRD is considered promising, which should be confirmed by well-designed and large sample studies. Future basic research and comprehensive clinical trials are needed to reach better understanding on the mechanisms of action and optimal targeted structure.

Keywords: deep brain stimulation; major depressive disorder; nerve nuclei; psychiatric surgery; treatment-resistant depression.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart. This flowchart represents the literature selection and elimination process taken to obtain the final 17 studies that were included in this meta-analysis.
Figure 2
Figure 2
Forest plots showing a summary of evaluation of respond, remission, recurrence and AEs rates in the open-label studies.
Figure 3
Figure 3
Forest plots showing a summary of the evaluation of the respond rates in the RCTs.
Figure 4
Figure 4
Funnel plots with the pseudo 95% confidence limits. (A) Response rates; (B) Remission rates; (C) Adverse events rates.
Figure 5
Figure 5
Sensitivity analysis. (A) Response rates; (B) Remission rates; (C) Adverse events rates.
See this image and copyright information in PMC

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