Authors' results and conclusions: Two technologies for treatment of refractory depression were considered for this Brief: transcranial magnetic resonance-guided focused ultrasound (tcMRg FUS) and deep brain stimulation (DBS). No reports on human studies on the use of tcMRg FUS for the treatment of refractory depression were identified, though ClinicalTrials.gov indicates that trials are underway. While DBS is an established technology for a number of neurological motor conditions, psychiatric applications are currently prohibited in several jurisdictions throughout Australia, and the use of the technology overseas to treat refractory depression is considered experimental/investigational. A small number of inconclusive, low level studies on DBS for depression were identified in the peer reviewed literature. Only one small randomised controlled trial of DBS for depression, claiming to be the first such trial, was identified. The trial failed to show any differences in treatment effectiveness between DBS and sham stimulation. A total of 71 serious adverse events related to DBS, including worsening depression, suicidal ideation, suicide attempt, implant site infection, and lead revision for reasons including but not limited to infection, were observed among nearly three quarters of study participants.

Authors' recommendations: There is a real need for an effective treatment for refractory depression with up to one third of diagnosed patients not responding to standard medication and psychological therapy. Although DBS is an established technology for other neurological conditions, published studies indicate that use of DBS for refractory depression is associated with high rates of serious adverse events. As such HealthPACT does not support public investment in DBS for refractory depression in clinical practice at this time, and recommends no further review of the evidence is warranted. The evidence base for tcMRg FUS for the treatment of refractory depression is immature, however initial studies on a very small number of humans published since the completion of this brief have reported improvements in depressive and obsessive/compulsive disorder symptoms. Given the ongoing research and the evolving evidence base on tcMRg FUS, HealthPACT recommends that this technology be reassessed in 24 months.

Project Status: Completed

Year Published: 2016

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)