Brain Stimulation in Psychiatric Treatment
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The past two decades have seen rapid progress in new and less invasive ways to stimulate the brain to study and treat psychiatric disorders. This authoritative reference provides an introduction to this emerging field of brain stimulation in psychiatry. Eight recognized experts present the latest research and results—and future challenges—for new techniques to electrically stimulate the central nervous system, including transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). This is the first book to both review these new techniques and place them in the context of existing somatic therapies in psychiatry.
Unlike electroconvulsive therapy (ECT, the standard choice for patients with treatment-resistant depression), these breakthrough methods enable us to affect selectively higher cognitive processes and mood systems by electrically stimulating—directly or indirectly—focal regions of the cortex and subcortical structures in the brain.
- The effectiveness of TMS and MST (MST is a higher-dosage, convulsive form of magnetic stimulation) is being studied worldwide. Results are encouraging: TMS has been reported to reduce the frequency of auditory hallucinations when administered to brain regions that show abnormal hyperactivity during hallucinations, and both TMS and MST induce far less electricity and stimulate more focal cortical regions than ECT, thus incurring fewer cognitive side effects.
- Although DBS—in which an electrode is implanted in a location relevant to the illness in question—is more invasive than other modalities, it is able to reach deeper structures in a highly focal way, which may be important for illnesses like obsessive-compulsive disorder, whose circuitry relies heavily on subcortical structures.
- VNS is less invasive than DBS but more invasive than TMS or MST. Efficacy of VNS is uncertain. Improvement appears to build over time, and the hope is that months or years after implantation patients may show dramatic improvements. Claims of enhanced efficacy with time have never been tested directly, and controlled, randomized trials are needed to determine whether VNS has a role in the treatment of major depression. Its effects are limited to the neuroanatomical connectivity of the vagus nerve.
Enriching our knowledge base in this exciting new field means more choices and therapeutic strategies for patients with conditions that resist conventional treatments. This fascinating work is a key reference for the promising future of brain stimulation in psychiatric treatment and is a must read for clinicians and residents alike.
- Introduction to the Review of Psychiatry Series
- Chapter 1. Transcranial Magnetic Stimulation in Depression
- Chapter 2. Transcranial Magnetic Stimulation Studies of Schizophrenia and Other Disorders
- Chapter 3. Deep Brain Stimulation in Psychiatry
- Chapter 4. Magnetic Seizure Therapy: Development of a Novel Convulsive Technique
- Chapter 5. Vagus Nerve Stimulation
- Benjamin D. Greenberg, M.D., Ph.D.
Ralph E. Hoffman, M.D.
Markus Kosel, M.D.
Sarah H. Lisanby, M.D.
John M. Oldham, M.D., M.S.
Michelle B. Riba, M.D., M.S.
Harold A. Sackeim, Ph.D.
Thomas E. Schlaepfer, M.D.
About the Authors
Sarah H. Lisanby, M.D., is Director of the Magnetic Stimulation Laboratory and Associate Professor of Clinical Psychiatry in the Department of Biological Psychiatry at Columbia College of Physicians and Surgeons, New York State Psychiatric Institute, in New York, New York.
This is a very well written, concise, state-of-the-art volume aimed at explaining the methods, rationale, and available evidence on both the safety and efficacy of four new potential psychiatric treatments—all of which rely on stimulating the central nervous system in specific ways at particular locations. Each chapter provides a balanced, objective, evidence-based appraisal of what we know and do not yet know about each of these exciting possible interventions. I most strongly recommend this book to clinicians managing treatment resistant conditions, to trainees in psychiatry and psychology, and to clinical investigators. The nature of psychiatric practice is changing rapidly. This volume anticipates the future by highlighting the recent and exciting developments of several promising somatic treatments. If you want to get a jump on the future, read this book.—A. John Rush, M.D., Professor and Vice Chairman for Research, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
This overview by leading experts encompasses the range of emerging electrical treatments for psychiatric disorders and documents a remarkable and expanding area of cross-fertilization between neurology and psychiatry. Its balanced, sophisticated presentations and rich bibliographies make it an ideal starting point for clinicians and neuroscientists with academic or practical interest in the subject.—Eric M. Wassermann, M.D., National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
Dr. Lisanby has produced a gem of a review on a very timely topic, namely, somatic treatments that involve electrical stimulation targeting the brain. . . . In my mind, the most compelling virtue of this book is its balance. The authors achieve the remarkable feat of conveying their enthusiasm for the potentials of the technique they address while being very candid about the limitations of the evidence in its current state.—Kevin J. Black, M.D., Journal of Clinical Psychiatry, 11/1/2005
Since the introduction of ECT 70 years ago, psychiatrists have employed electrical stimulation of the brain to treat certain neuropsychiatric disorders. Over the past two decades, researchers have developed newer, less invasive and perhaps more selective, techniques to stimulate cortical and subcortical systems. These techniques are the focus of this timely and important volume, which summarizes the current status of transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). Edited and authored by the leaders in the rapidly emerging field of brain stimulation, this book is a 'must read' for clinicians and scientists alike who are interested in understanding brain-behavior relations and providing state-of-the-art care for persons with neuropsychiatric disorders.—C. Edward Coffey, M.D., DFAPA, Professor of Psychiatry and of Neurology, Vice President, Behavioral Health Services, Henry Ford Health System, Detroit, Michigan
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