Does Deep Brain Stimulation Work for Bipolar Disorder?

Deep brain stimulation has been approved to treat Parkinson’s disease and movement disorders, but it is not without its risks. Complications can arise from the implantation of the device, the device itself or from device stimulation. Specific risks vary depending on where the leads are implanted, which is different for different disorders.

Risks of Deep Brain Stimulation

 Complications from deep brain stimulation include:

• Serious adverse events including hemorrhage, ischemic lesions, seizures or death (in 1-2 percent of patients)
• Infection (in 3-5 percent of patients – may require device removal (explantation))
• Misplacement of the leads (in up to 10 percent of patients – requires additional surgery)
• Device-related complications including malfunction, movement of leads, skin erosion and device fractures (in up to 25 percent of patients – generally requires additional surgery)
• Stimulation side effects including unusual muscle sensations (parenthesis), muscle spasms, visual disturbances, mood changes and pain (may be resolved with stimulation changes)

Does Deep Brain Stimulation Work for Bipolar Disorder?

It’s too early to tell whether deep brain stimulation works for bipolar disorder. At this time we only have one recent, small study to pin our hopes on. In the Archives of General Psychiatry this month there is a published study on deep brain stimulation in the treatment of treatment-resistant unipolar and bipolar depression.

And the data is miraculous.

Understand that when it comes to treatment-resistant unipolar and bipolar depression, people frequently just don’t get better. And what’s more, no therapeutic techniques are indicated for treatment-resistance as, after all, you are treatment-resistant. So if deep brain stimulation can help people who typically don’t get better, I’m all for it.

The data in this study is from 17 people, 10 with unipolar major depressive disorder and 7 with bipolar depression. As I said, it’s a small study; however, this is common with studies of implanted devices due to the costs and risks involved.
And the data looks like this:

• At the start of treatment patients suffered from severe depression symptoms and had failed at least four previous treatments plus electroconvulsive therapy
• After six months depression scores decreased by 43 percent and 41 percent of people experienced a positive response
• After one year, depression scores decreased 43 percent (compared to start of treatment) and 36% of people experienced a positive response
• After two years, depression scores decreased 70.1 percent (compared to start of treatment) and 92 percent of people experienced a positive response

What Does this Study on Deep Brain Stimulation Mean?

Honestly, the numbers after two years are so good I had to do a double take. I’ve never seen anything with that kind of promise in treatment-resistant patients.

But like I said, it’s one, tiny study and it remains to be seen whether these results can be duplicated. There are a lot of variables at work here, so that could be very tough to do.

Nevertheless, I think this study creates hope on two fronts:

1. We are better understanding the underlying mechanisms of depression if we can pinpoint it in the brain.
2. We may find a way of treating depression so successfully it can be thought of as a cure.

In both cases we are a long ways away from these statements but I believe this study is reason for hope. And hope for people who have tried, and failed, everything else is priceless.

For more information about this study please see: Archives of General Psychiatry, Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Unipolar and Bipolar Depression.