Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

Abstract

Depression is the leading cause of disability worldwide, and it is related to high suicide rates. Furthermore, a great number of patients do not respond to any of the available treatments. Deep brain stimulation (DBS), a versatile technology with expanding indications, is considered a potential treatment for resistant depression. However, in over 10 years of clinical research, its efficacy has not been completely proven. Although new trials using DBS for treatment-resistant depression keep emerging, two of the three Level I evidence-based studies recently conducted have not provided conclusive data. Methodological limitations and major biases have compromised the obtention of clearer results. In this systematic review of the literature, we intend to critically assess the clinical trials performed in this field.

Resumo

A depressão é a maior causa de incapacitação em nível mundial, e ela está relacionada com altos índices de suicídio. Ademais, um grande número de pacientes não responde a nenhum dos tratamentos disponíveis. A estimulação cerebral profunda (ECP), uma técnica versátil com indicações em expansão, é considerada um tratamento potencial para depressão refratária. Contudo, em mais de 10 anos de pesquisas clínicas, sua eficácia ainda não foi completamente comprovada. Embora novos estudos utilizando ECP para tratamento da depressão refratária venham sendo realizados, dois dos três ensaios recentemente conduzidos baseados em evidência com Nível 1 não forneceram dados conclusivos. Limitações metodológicas e vieses importantes comprometeram a obtenção de resultados mais claros. Nesta revisão sistemática da literatura, pretendemos avaliar criticamente as pesquisas clínicas executadas nesta área.

Keywords

deep brain stimulation - treatment-resistant depression - refractory depression

Palavras-chave

estimulação cerebral profunda - depressão resistente ao tratamento - depressão refratária

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