Recently, there has been a surge of interest in using deep brain stimulation (DBS) to treat patients suffering from treatment-resistant depression (TRD). While DBS has been regarded as an efficient and safe treatment for many conditions over the last 20 years, and although DBS research trials involving TRD patients show encouraging evidence of remission, recent DBS TRD follow-up studies have reported significant rates of postoperative suicidal ideation, as well as suicide attempts and deaths. Given the vulnerable nature of TRD patients with respect to suicide, if the postoperative DBS adjustment process contributes to an increased risk of suicidality among them, then there is a pressing need to investigate this problem. Based on current clinical trial follow-up data, does the suicidality risk-versus-remission benefit ratio favor the use of DBS in TRD patients? The purpose of this article is to examine whether adjusting enrollment criteria, such as excluding TRD patients with a history of suicide attempts or anger/impulsivity, could diminish DBS trial research suicidality, given the absence of uniformity in DBS trial eligibility protocols.
Open Peer Commentaries.
- Time to Reconsider Deep Brain Stimulation
- Managing Suicide Risk in Experimental Treatments of Treatment-Resistant Depression
- The Complexity of Deep Brain Stimulation and Suicidality in Patients with Treatment Resistant Depression
- Deep Brain Stimulation Research Protocols and Depressive Patients with Previous Suicidality: We Can't Afford to Lose Focus
- The Ethical Import of Patient Selection
- Rethinking Vulnerability