Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China; Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, China.
Institute of Neuroscience, Chongqing Medical University, China; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, China; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2018 Mar 2;82:224-232. doi: 10.1016/j.pnpbp.2017.11.012. Epub 2017 Nov 13.
Deep brain stimulation (DBS) has been applied in treatment-resistant depression (TRD) as a putative intervention targeting different brain regions. However, the antidepressant effects of DBS for TRD in recent clinical trials remain controversial.
We searched Scopus, EMBASE, the Cochrane Library, PubMed, and PsycINFO for all published studies investigating the efficacy of DBS in TRD up to Feb 2017. Hamilton depression rating scale (HDRS) scores and Montgomery-Asberg depression rating scale (MARDS) scores were compared between baseline levels and those after DBS using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The pooled response and remission rates were described using Risk Difference with 95% CIs.
We identified 14 studies of DBS in TRD targeting the subcallosal cingulate gyrus (SCG), ventral capsule/ventral striatum (VC/VS), medial forebrain bundle (MFB), and nucleus accumbens (NAcc). The overall effect sizes showed a significant reduction in HDRS after DBS stimulation in these four regions, with a standardized mean difference of -3.02 (95% CI=-4.28 to -1.77, p<0.00001) for SCG, -1.64 (95% CI=-2.80 to -0.49, p=0.005) for VC/VS, -2.43 (95% CI=-3.66 to -1.19, p=0.0001) for MFB, and -1.30 (95% CI=-2.16 to -0.44, p=0.003) for NAcc. DBS was effective, with high response rates at 1, 3, 6, and 12months. Some adverse events (AEs), especially some specific AEs related to targeting regions, occurred during the DBS treatment.
DBS significantly alleviates depressive symptoms in TRD patients by targeting the SCG, VC/VS, MFB, and NAcc. Several adverse events might occur during DBS therapy, although it is uncertain whether some AEs can be linked to DBS treatment. Further confirmatory trials are required involving larger sample sizes.
深部脑刺激（DBS）已被应用于治疗抵抗性抑郁症（TRD），作为一种针对不同脑区的潜在干预措施。然而，最近的临床试验中 DBS 治疗 TRD 的抗抑郁效果仍存在争议。
我们检索了 Scopus、EMBASE、Cochrane 图书馆、PubMed 和 PsycINFO，以获取截至 2017 年 2 月所有关于 DBS 治疗 TRD 疗效的研究。使用标准化均数差（SMD）及其 95%置信区间（CI）比较基线水平和 DBS 后的 Hamilton 抑郁量表（HDRS）评分和 Montgomery-Asberg 抑郁量表（MARDS）评分。采用风险差（Risk Difference）及其 95%CI 描述的 pooled response 和 remission 率。
我们共纳入了 14 项关于 DBS 治疗 TRD 的研究，这些研究的靶点分别是扣带回下托（subcallosal cingulate gyrus，SCG）、腹侧被盖区/腹侧纹状体（ventral capsule/ventral striatum，VC/VS）、内侧前额叶束（medial forebrain bundle，MFB）和伏隔核（nucleus accumbens，NAcc）。总体效应大小显示，这四个区域的 DBS 刺激后 HDRS 显著降低，SCG 的标准化均数差为-3.02（95%CI=-4.28 至-1.77，p<0.00001），VC/VS 为-1.64（95%CI=-2.80 至-0.49，p=0.005），MFB 为-2.43（95%CI=-3.66 至-1.19，p=0.0001），NAcc 为-1.30（95%CI=-2.16 至-0.44，p=0.003）。DBS 是有效的，在 1、3、6 和 12 个月时的应答率较高。在 DBS 治疗期间，发生了一些不良事件（AEs），尤其是一些与靶点相关的特定 AEs。
通过靶向扣带回下托（SCG）、腹侧被盖区/腹侧纹状体（VC/VS）、内侧前额叶束（MFB）和伏隔核（NAcc），DBS 可显著减轻 TRD 患者的抑郁症状。尽管不确定某些 AEs 是否与 DBS 治疗有关，但在 DBS 治疗期间可能会发生一些不良事件。需要进行进一步的大样本量验证性试验。
