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 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 , DBS has also been used to treat ,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.(