Brain stimulation therapies for neuropsychiatric disease.

ECT is a well-established, effective, and safe treatment for many neuropsychiatric conditions, especially major depression. However, ECT is also associated with a high relapse rate, notable side-effects, and significant social stigma. Additionally, ECT is ineffective in a sizable minority of patients. Based on this, several other brain stimulation therapies are currently under active investigation. VNS is approved in many countries for the treatment of treatment-resistant epilepsy and TRD. The available data suggest long-term VNS may have clinically significant antidepressant effects, though more data are needed to clarify how VNS might optimally be used in the treatment of neuropsychiatric disease.TMS offers a noninvasive technique for modulating neural function, and preliminary studies support acute efficacy in the treatment of depression and several other neuropsychiatric illnesses; results from more definitive studies are pending. Although early in development,MST may develop as a form of convulsive therapy that minimizes characteristic side-effects of ECT while achieving similar efficacy; clearly, more data from larger, controlled trials are needed, tDCS is in the early stages of development, but may prove to be an effective, noninvasive alternative for treatment-resistant patients with psychiatric disorders. DBS is the most invasive of these brain stimulation therapies, but may become an effective intervention for patients who have failed other available treatments (including ECT). Very preliminary data support the efficacy of DBS for specific neuropsychiatric conditions, and more definitive data are eagerly awaited. Beyond their potential efficacy for neuropsychiatric conditions, these various brain stimulation therapies may help improve our understand-ing of the neurobiology of neuropsychiatric disease.