The University of Queensland Southern Clinical School, Queensland, Australia.
Metro South Health Service, Woolloongabba, Australia.
Depress Anxiety. 2018 May;35(5):468-480. doi: 10.1002/da.22746. Epub 2018 Apr 26.
Deep brain stimulation is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers.
We performed a systematic review and meta-analysis on the effectiveness of deep brain stimulation (DBS) in depression. Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System, and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, crossover, and parallel-group trials in which DBS was compared with sham treatment using validated scales.
Ten papers from nine studies met inclusion criteria, all but two of which were double-blinded RCTs. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 190 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (OR = 5.50; 95% CI = 2.79, 10.85; p < .0001) and reductions in mean depression score (SMD = -0.42; 95% CI = -0.72, -0.12; p = .006). However, the effect was attenuated on some of the subgroup and sensitivity analyses, and there were no differences for most other outcomes. In addition, 84 participants experienced a total of 131 serious adverse effects, although not all could be directly associated with the device or surgery. Finally, publication bias was possible.
DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.
深部脑刺激术越来越多地被用于治疗抵抗性抑郁症。盲法、活性与假刺激治疗的随机对照试验数量有限。
我们对深部脑刺激术（DBS）治疗抑郁症的效果进行了系统评价和荟萃分析。我们在 Cochrane 对照试验中心注册数据库、PubMed/Medline、Embase 和 PsycINFO、中国生物医学文献服务系统和中国知识资源总库中搜索了单盲或双盲、交叉和平行组试验，其中 DBS 与假刺激治疗使用了经过验证的量表进行了比较。
9 项研究的 10 篇论文符合纳入标准，除了 2 项以外均为双盲 RCT。主要结局是抑郁症状的减轻。对 190 名参与者的数据进行了合并。与假刺激相比，接受活性治疗的患者应答率更高（OR=5.50；95% CI=2.79，10.85；p<.0001），抑郁评分的均值下降幅度更大（SMD=-0.42；95% CI=-0.72，-0.12；p=0.006）。然而，一些亚组和敏感性分析结果表明效果减弱，大多数其他结局没有差异。此外，84 名参与者共经历了 131 次严重不良事件，尽管并非所有事件都能直接与设备或手术相关。最后，可能存在发表偏倚。
DBS 可能对治疗抵抗性抑郁症有希望，但在进一步数据出现之前仍属于实验性治疗。
