Deep brain stimulation (DBS) has provided remarkable therapeutic benefits for people with a variety of neurological disorders. Despite the uncertainty of the precise mechanisms underlying its efficacy, DBS is clinically effective in improving motor function of essential tremor, Parkinson's disease and primary dystonia and in relieving obsessive-compulsive disorder. Recently, this surgical technique has continued to expand to other numerous neurological diseases with encouraging results. This review highlighted the current and potential future clinical applications of DBS.

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Deep brain stimulation.

European archives of psychiatry and clinical neuroscience

The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder

Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder (MDD) and 2 or more prior antidepressant treatment failures (often referred to as treatment-resistant depression [TRD]). These patients are less likely to recover with medications alone and often consider nonpharmacologic treatments such as rTMS. Data sources We searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and the International Pharmaceutical Abstracts for studies comparing rTMS with a sham-controlled treatment in TRD patients ages 18 years or older. Study selection We included 18 good- or fair-quality TRD studies published from January 1, 1980, through March 20, 2013. Data extraction We abstracted relevant data, assessed each study's internal validity, and graded strength of evidence for change in depressive severity, response rates, and remission rates. Results rTMS was beneficial compared with sham for all outcomes. rTMS produced a greater decrease in depressive severity (high strength of evidence), averaging a clinically meaningful decrease on the Hamilton Depression Rating Scale (HDRS) of more than 4 points compared with sham (mean decrease = -4.53; 95% CI, -6.11 to -2.96). rTMS resulted in greater response rates (high strength of evidence); those receiving rTMS were more than 3 times as likely to respond as patients receiving sham (relative risk = 3.38; 95% CI, 2.24 to 5.10). Finally, rTMS was more likely to produce remission (moderate strength of evidence); patients receiving rTMS were more than 5 times as likely to achieve remission as those receiving sham (relative risk = 5.07; 95% CI, 2.50 to 10.30). Limited evidence and variable treatment parameters prevented conclusions about which specific treatment options are more effective than others. How long these benefits persist remains unclear. Conclusions For MDD patients with 2 or more antidepressant treatment failures, rTMS is a reasonable, effective consideration.

https://www.psychiatrist.com/read-pdf/29758

Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis.

The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuro-endocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation. Left cervical VNS is an approved therapy for refractory epilepsy and for treatment-resistant depression. Right cervical VNS is effective for treating heart failure in preclinical studies and a phase II clinical trial. The effectiveness of various forms of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, and other conditions has not been investigated beyond small pilot studies. The relationship between depression, inflammation, metabolic syndrome, and heart disease might be mediated by the vagus nerve. VNS deserves further study for its potentially favorable effects on cardiovascular, cerebrovascular, metabolic, and other physiologic biomarkers associated with depression morbidity and mortality.

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Vagus Nerve Stimulation

Major depressive disorder (MDD) is common and costly. Over the course of a year, between 13.1 million and 14.2 million people will experience MDD. Approximately half of these people seek help for this condition, and only 20 percent of those receive adequate treatment. For those who do initiate treatment for their depression, approximately 50 percent will not adequately respond following acutephase treatment; this refractory group has considerable clinical and research interest. Patients with only one prior treatment failure are sometimes included in this group, but patients with two or more prior treatment failures are a particularly important and poorly understood group and are considered to have treatment-resistant depression (TRD). These TRD patients represent a complex population with a disease that is difficult to manage.

Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults

/pdf/nonpharmacologic-interventions-for-treatment-resistant-3i8eikfu49.pdf

Nonpharmacologic interventions for treatment-resistant depression in adults. Comparative Effectiveness Review Number 33. AHRQ Publication No. 11-EHC056-EF

Patricia Keener

Papers

Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults

Nonpharmacologic interventions for treatment-resistant depression in adults. Comparative Effectiveness Review Number 33. AHRQ Publication No. 11-EHC056-EF

Abbreviations and Full Names of Diagnostic Scales and Other Instruments

Data Abstraction Forms