Abstract
DEAR SIR,
Recently, an interesting argument has been raised that the application of deep brain stimulation (DBS) for the potential treatment of psychiatric disorders should not be considered a form of psychosurgery, with the implication that DBS should not be subject to the same regulatory constraints as other forms of destructive psychosurgery. 1 Several arguments have been raised. The first is that the term ‘psychosurgery’ is inappropriate and should be replaced with the terminology ‘neurosurgery for psychiatric disorders’. This seems reasonable.
The second argument, however, that DBS should not be considered a form of neurosurgery, is considerably more problematic. The argument for this is that DBS creates no irreversible lesion and that the physiological changes generated by stimulation can be related to symptomatic change. Although this clearly appears to be the case, based on the small numbers of patients who have undergone this procedure for psychiatric disorders, we cannot conclude this with great certainty. The implantation of stimulating electrodes and wires, although very small, does have potential implications for the tissue through which the wires pass. In addition, implantation of the DBS electrode is clearly a neurosurgical technique and as such there are neurosurgical complications, such as haemorrhage, postoperative seizure and general operative complications. 2
To consider DBS to be only a brain stimulation technique rather than a neurosurgical procedure runs the risk of minimizing these effects in the minds of patients. Given the rather ignoble history of psychiatry in regards to the development of somatic treatments, we need to be extremely cautious in the perception that we create in the minds of the public and the way in which information about potentially controversial new techniques is presented. Related to this, it seems appropriate that ongoing special regulatory review occurs for DBS. Currently, in Victoria, review of patients undergoing DBS for the treatment of intractable depression and other psychiatric disorders is required by the Victorian psychosurgery review board. This independent regulatory review provides a considerable degree of reassurance to the public. Importantly, it also provides reassurance to individual patients and their families that this procedure is subject to a considerable degree of independent scrutiny. At this stage in the development of DBS, this seems highly appropriate.
Declaration: Professor Fitzgerald has received research support from Medtronic Inc. to support a clinical trial of DBS in patients with refractory depression.