Deep Brain Stimulation for Treatment Resistant Depression: Postoperative Feelings of Self-Estrangement, Suicide Attempt
- PDF / 170,072 Bytes
- 9 Pages / 547.087 x 737.008 pts Page_size
- 13 Downloads / 194 Views
ORIGINAL PAPER
Deep Brain Stimulation for Treatment Resistant Depression: Postoperative Feelings of Self-Estrangement, Suicide Attempt and Impulsive–Aggressive Behaviours Frederic Gilbert
Received: 11 December 2012 / Accepted: 20 January 2013 # Springer Science+Business Media Dordrecht 2013
Abstract The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? Keywords Deep Brain Stimulation . Eligibility . Exclusion . Experimental trial . Feelings of self-estrangement . Impulsive–aggressive disorder . Suicide . Treatment Resistant Depression
Introduction The history of depression accounts for many changes in the ways medicine has explained the aetiology of F. Gilbert (*) Ethics & Bionics/Nanomedicine, ARC Centre of Excellence for Electromaterials Science (ACES), University of Tasmania, Tasmania, Australia e-mail: [email protected]
depression, and therefore how patients have been treated. In the last few years, there has been growing interest in using experimental Deep Brain Stimulation (DBS) to alleviate the symptoms of patients suffering from Treatment Resistance Depression (TRD). TRD patients are by definition resistant to the mainstream treatment options of pharmacotherapies, cognitive behavioral therapy, and Electroconvulsive Therapy [1]. Although TRD patients enrolled in experimental DBS trials show encouraging evidence of remission, recent follow-up studies have highlighted a significant rate of correlation with postoperative suicidal attempts and deaths from suicide [2–4]. Significant evidence of DBS postoperative suicide attempts and suicide deaths have also been observed within non-TRD patient populations [5]. There is growing evidence demonstrating that TRD patients are particularly vulnerable to suicide. With or without experimental clinical research trials, the presence of depression is probably the single most important predictor of suicidality (suicidal thinking and behaviour). Studies have highlighted the lethal nature of severe depression from suicide [6–9]. Studies have revealed suicidality risk to be extremely high, approximately one third of TRD report significant suicidal ideas or gestures (out of 92 patients) [10]; while suicide attempts in TRD had a higher frequency compared to non-TRD patients [11]. The purpose of this article is to examine the eth
Data Loading...
