Thursday, November 08, 2007

Guest Blogger Dr. Peter Rabins on Deep Brain Stimulation

A while back we were talking about treatments for depression and some of our commenters asked about the newer, non-pharmacologic treatments out there. It was on my list, or maybe I was hoping Roy would jump in with some answers-- he likes gadgets and gizmos. We'd moved on and I forgot about this, but then we got an emailed request from JCAT in South Africa, asking for our thoughts on surgical treatments for depression, specifically Deep Brain Stimulation and Vagal Nerve Stimulation. I can't say I've ever recommended these treatments for any of my patients, I've never met anyone who has had them, and I don't have an opinion. I did, however, hear Dr. Peter Rabins talk about DBS as a treatment for depression last year, and so I thought I'd ask his opinion.

Dr. Rabins is a Professor of Psychiatry at Johns Hopkins Hospital where he is co-director of the division of Geriatric Psychiatry and Neuropsychiatry. He is the author of The 36-Hour Day, and more recently of Getting Old Without Getting Anxious.

Dr. Rabins writes:

There has been an amazing amount written in the popular
press about the potential for Deep Brain Stimulation
(DBS) to be usedto treat certain psychiatric syndromes.
Right now, there are preliminary and promising results
for severe, treatment-resistant major depression and
OCD but very little information has been published in
the peer-reviewed literature.

In Europe, DBS has also been used to treat anorexia 
nervosa,various substance abuse disorders, and even
aggressive behavior. Given what happened with
'lobotomy' surgery 60 years ago, I believe it is
incumbent upon the mental health community and
especially psychiatry to publicly and persistently
urge that the topic be approached from a scientific
point of view, that carefully designed studies with
long-term follow up data bemade publicly available,
and that very ill and vulnerable individuals be
protected from the harm and abuse that can result
from inappropriate claims, unnecessary and
non-beneficial surgery, and being taken advantage
of financially.

Many ethical and careful researchers have begun to
study DBS for psychiatric illness but it will take
time before results can tell us whether it is helpful
and worthwhile. In the meantime, it is best to keep
expectations down, to remind people that this is a
very expensive treatment that will likely only be
used for severe disease that has not responded to other
less invasive and less expensive approaches, and
that the treatments we have now for major depression,
including ECT,help the majority of very ill individuals.