Title: The Effectiveness of Deep Brain Stimulation in the Treatment of Bipolar Disorder
Authors: Dr Adnan Bashir Bhatti, MD, Dr Anwar-ul-Haq, Dr Farhan Ali
DOI: https://dx.doi.org/10.18535/jmscr/v4i11.111
Abstract
Background: Bipolar disorder (BD) is a chronic debilitating illness associated with socioeconomic burdens on patients and their caregivers. Presenting a challenge to diagnose, the management of bipolar disorder with existing first-line pharmacologic and psychological therapies has not yielded much significant results. As a result, there is the need to explore other more efficacious modalities of treatment of the condition. This systematic review analyzes the efficacy of deep brain stimulation (DBS), a novel neuropsychosurgical intervention, in managing bipolar disorder, with specific focus on neuroanatomical and neurophysiological circuitries involved in the pathophysiology of bipolar disorder.
Methods: A search of online databases was conducted using the following keywords: deep brain stimulation, bipolar disorder, mania, depression, and treatment. Articles selected for use included those which have been peer-reviewed, and contained either case reports, case series, open-label, single-blind, and randomized double-blind sham-controlled studies.
Results: Significant evidence supports the increased use of DBS in bipolar depression, with a reduced risk of triggering mania in bipolar depressed patients. Low-quality evidence also suggests increased positive response in manic patients with bipolar disorder. There is minimal information in medical literature relating to acute adverse effects associated with the use of DBS in bipolar disorder. However, there is a dearth of evidence concerning what happens to patients in terms of relapse, response, or remission, years after cessation of stimulation.
Conclusion: The use of DBS in patients with BD requires a lot more exploration. However, present evidence shows that it is effective for patients with bipolar depression. Its use in manic individuals has not been well elucidated. Further research should explore its efficacy in manic individuals; and especially how to further refine the approach in order to increase efficacy and reduce the risk of adverse events in patients with bipolar disorder.
Keywords: Bipolar disorder, deep brain stimulation, mania, depression, unipolar depression.
References
1. Miller K. Bipolar disorder: etiology, diagnosis, and management. J Am Acad Nurse Pract. 2006;18:368–373.
2. Valente SM, Kennedy BL. End the bipolar tug-of-war. Nurse Pract. 2010;35:36–45.
3. Ketter TA. Diagnostic features, prevalence, and impact of bipolar disorder. J Clin Psychiatry. 2010;71:e14
4. Kessler RC, Bergland P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602
5. Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar disorder. Arch Gen Psychiatry. 2002;59: 530–7.
6. Geddes JR, Miklowitz, DJ.Treatment of bipolar disorder.Lancet. 2013;381:1672–1682.
7. Lipsman N, McIntyre RS, Giacobbe P, Torres C, Kennedy SH, Lozano AM. Neurosurgical treatment of bipolar depression: defining treatment resistance and identifying surgical targets. Bipolar Disord. 2010;12(7):691-701.
8. Vieta E, Goikolea, JM. Atypical antipsychotics: newer options for mania and maintenance therapy. Bipolar Disord.2005;7(Suppl 4):21–33.
9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders.5th ed. Washington, DC: American Psychiatric Association; 2013.
10. McCormick U, Murray B, McNew B. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses.J Am Acad Nurse Pract.2015;27(9):530–542.
11. Oldani L, Altamura AC, Abdelghani M, Young AH. Brain stimulation treatments in bipolar disorder: a review of the current literature.World J Biol Psychiatry. 2016;17(7):482-94.
12. Hirschfeld RMA, Bowden CL, Gitlin MJ, et al. Practice guideline for the treatment of patients with bipolar disorder (revision) [April 14, 2006].Am J Psychiatry. 2002;159(Suppl):1–35.
13. Mukherjee S, Sackeim HA, Schnurr DB. Electroconvulsive therapy of acute manic episodes: a review. Am J Psychiatry. 1994;151:169–76.
14. Mukherjee S, Sackeim HA, Lee C. Unilateral ECT in the treatment of manic episodes. Convulsive Ther. 1988;4:74–80.
15. Hilty, DM, Leamon, MH, Lim, RF, Kelly, RH & Hales, RE. A review of bipolar disorder in adults.Psychiatry (Edgmont). 2006;3(9):43–55.
16. Mi, K 2016, Use of deep brain stimulation for major affective disorders (review). ExpTher Med. 2016;12:2371-2376.
17. Rizvi SJ, Donovan M, Giacobbe P, Placenza F, Rotzinger S, Kennedy SH.Neurostimulation therapies for treatment resistant depression: a focus on vagus nerve stimulation and deep brain stimulation. Int Rev Psychiatry.2011; 23:424-43.
18. Williams NR,Okun MS. Deep brain stimulation (DBS) at the interface of neurology and psychiatry.JClin Invest. 2013;123(11):4546–4556.
19. Cleary DR, Ozpinar A, RaslanAM,Ko AL. Deep brain stimulation for psychiatric disorders: where we are now.Neurosurg Focus. 2015;38(6):E2.
20. Coenen VA, Honey CR, Hurwitz T, Rahman AA, McMaster J, Burgel U, et al. Medial forebrain bundle stimulation as a pathophysiological mechanism for hypomania in subthalamic nucleus deep brain stimulation for Parkinson’s disease. Neurosurgery.2009; 64:1106–1114.
21. Schlaepfer TE, Bewernick BH, Kayser S, Mädler B, Coenen VA. Rapid effects of deep brain stimulation for treatment-resistant major depression.Biol Psychiatry. 2013;73(12):1204–1212.
22. Jiménez F, Velasco F, Salin-Pascual R, Hernández JA, Velasco M, Criales JL, et al. A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle. Neurosurgery.2005;57:585–593.
23. Sartorius A, et al. Remission of major depression under deep brain stimulation of the lateral habenula in a therapy-refractory patient. Biol Psychiatry. 2010;67(2):e9–e11.
24. Mayberg HS. Targeted electrode-based modulation of neural circuits for depression.J.Clin. Invest.2009;119:717–25
25. Price JL, DrevetsWC. 2010. Neurocirc-uitry of mood disorders. Neuropsychopha-rmacology.2010;35:192–216.
26. Riva-Posse P, Holtzheimer PE, Garlow SJ, Mayberg HS. Practical considerations in the development and refinement of subcallosal cingulate white matter deep brain stimulation for the treatment resistant depression. WorldN eurosurg. 2012;pii: S1878-8750.
27. Holtzheimer PE, Kelley ME, Gross RE, Filkowski MM, Garlow SJ, Barrocas A, et al.Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry.2012;69:150-158.
28. Puigdemont D, Pérez-Egea R, Portella MJ, Molet J, de Diego‑Adeliño J, Gironell A, et al. Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment‑resistant major depression. Int J Neuropsychopharm-acol.2012;15:121-133.
29. Holtzheimer, PE, Mayberg, HS.Deepbrain stimulation for psychiatric disorders.Annu. Rev. Neurosci. 2011;34:289–307
30. Malone DA Jr, Dougherty DD, Rezai AR, Carpenter LL, Friehs GM, Eskandar EN, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009;65:267-275.
31. Humphries MD, Prescott TJ. The ventral basal ganglia, a selection mechanism at the crossroads of space, strategy, and reward.Prog.Neurobiol.2010;90:385–417
32. Sesack SR, Grace AA. Cortico-basal ganglia reward network: microcircuitry. Neuropsychopharmacology.2010;35:27–47
33. Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology.2008;33:368–77
34. Bewernick BH, Hurlemann R, Matusch A, Kayser S, Grubert C, et al. Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol. Psychiatry.2010;67:110–16
35. Bewernick BH, Kayser S, Sturm V, Schlaepfer TE.Longterm effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuropsychophar-macology.2012;37:1975–1985.
36. Kiening K, Sartorius A.A new translational target for deep brain stimulation to treat depression.EMBOMol Med.2013;5:1151–1153.
37. Sartorius A, Henn FA.Deep brain stimulation of the lateral habenula in treatment resistant major depression.Med Hypotheses.2007;69:1305–1308.
38. Drevets WC, Price JL.Neuroimaging and neuropathological studies of mood disorders. In: Licinio JWM, ed. Biology of depression: from novel insights to therapeutic strategies. Weinheim: Wiley-VCH Verlag GmbH & Co; 2005
39. Lyoo IK, Kim MJ, Stoll AL, Demopulos CM, Parow AM, DagerSR,et al. Frontal lobe gray matter density decreases in bipolar I disorder. Biol Psychiatry. 2004;55:648–651.
40. Nugent AC, Milham MP, Bain EE, Mah L, Cannon DM, Marrett S, et al. Cortical abnormalities in bipolar disorder investigated with MRI and voxel-based morphometry. Neuroimage.2006;30:485–497.
41. Drevets WC, Gadde K, Krishnan KRR. Neuroimaging studies of depression. In: Charney DS, Nestler EJ, Bunney BS, eds. The neurobiological foundation of mental illness, 2nd ed. New York: Oxford University Press; 2004.
42. Drevets WC, Videen TO, Price JL, Preskorn SH, Carmichael ST, RaichleME.A functional anatomical study of unipolar depression.J Neurosci. 1992;12:3628–3641.
43. 41. Drevets WC, Price JL,Furey ML. Brain structural and functional abnorm-alities in mood disorders: implications for neurocircuitry models of depression. BrainStructFunct.2008;213:93–118.
44. Benabid AL, Pollak P, Gervason C, Hoffmann D, Gao DM, et al. Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet.1991;337:403–6
45. Iremonger KJ, Anderson TR, Hu B, Kiss ZH. Cellular mechanisms preventing sustained activation of cortex during subcortical high-frequency stimulation. J. Neurophysiol.2006;96:613–21
46. Messina G, Rizzi M, Cordella R, Castiglione M, GambiniO,Franzini, A. Deep brain stimulation of the subgenual cortex for treatment of refractory bipolar disorder: case report and literature review.JPsychopathol. 2015;21:93-96
47. Mayberg HS, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45(5):651–660.
48. Drevets WC, Ongur D, Price JL. Neuroimaging abnormalities in the subgenual prefrontal cortex: implications for the pathophysiology of familial mood disorders. Mol Psychiatry. 1998;3(3):220–226.
49. Haq IU, Foote KD, Goodman WK, Ricciuti N, Ward H, Sudhyadhom A, etal.Acase of mania following deep brain stimulation for obsessive compulsive disorder. Stereotact Funct Neurosurg. 2010;88:322–328
50. Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopha-rmacology. 2006;31:2384–2393
51. Miyawaki E, Perlmutter JS, Troster AI, Videen TO, Koller WC. The behavioral complications of pallidal stimulation: a case report. Brain Cogn. 2000;42:417–434
52. Bejjani BP, Damier P, Arnulf I, Thivard L, Bonnet AM, Dormont D, et al. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med.1999;340:1476–1480
53. Benabid AL, Chabardes S, Mitrofanis J, Pollak P. Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol. 2009;8:67–81.
54. Downar J, Daskalakis ZJ. New targets for rTMS in depression: a review of convergent evidence. Brain Stimul. 2013;6(3):231–240.
55. Mayberg H. Optimizing subcallosal cingulate DBS for treatment resistant depression. Society of Biological Psychiatry 68th Annual Scientific Convention, May 16–18, 2013. San Francisco; 2013
56. Coenen VA, Panksepp J, Hurwitz TA, Urbach H, Madler B. Human medial forebrain bundle (MFB) and anterior thalamic radiation (ATR): imaging of two major subcortical pathways and the dynamic balance of opposite affects in understanding depression. J Neuropsyc-hiatry ClinNeurosci. 2012;24(2):223–236.
57. Ramasubbu RA. Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study. Society of Biological Psychiatry 68th Annual Scientific Convention, May 16–18, 2013. San Francisco;2013.
58. Kennedy SH, Giacobbe P, Rizvi SJ, Placenza FM, Nishikawa Y, Mayberg HS and Lozano AM: Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry. 2011;168: 502-510.
59. Malone DA Jr. Use of deep brain stimulation in treatment‑resistant depress-sion. CleveClin J Med. 2010;77(Suppl 3):S77-S80.
60. Santaniello S, Fiengo G, Glielmo L, Grill W. Closed-loop control of deep brain stimulation: a simulation study. IEEE Trans Neural SystRehabil Eng.2011; 19:15-24.
61. Kuncel AM, Birdno MJ, Swan BD, Grill WM. Tremor reduction and modeled neural activity during cycling thalamic deep brain stimulation. Clin Neurophysiol. 2012;123:1044-1052.
62. Knapp CM, Tozier L, Pak A, Ciraulo DA, Kornetsky C. Deep brain stimulation of the nucleus accumbens reduces ethanol consumption in rats. Pharmacol BiochemBehav.2009;92:474–479.
63. Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol. Psychiatry. 2008;64:461–67.
64. Dougherty DD, Rezai AR, Carpenter LL, Howland RH, Bhati MT, O’Reardon JP, et al. A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression.Biol Psychiatry. [epub ahead of print]; 2014.