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Psychiatric neuromodulation: the underappreciated importance of pre- and post-treatment care

Molecular Psychiatry volume 26, pages 366–369 (2021)Cite this article

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As many as 25% of patients with psychiatric conditions are treatment-refractory, remaining symptomatic despite optimized pharmacologic, and psychotherapeutic therapies [1]. As a result, several neuromodulation strategies have been developed to address the need for safe and effective therapeutic options. These include noninvasive options, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), and surgical options, such as deep brain stimulation (DBS) and stereotactic ablation. The conditions being investigated in active trials span the clinical spectrum to include the most common mood and anxiety disorders, namely, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD), with additional trials in anorexia nervosa (AN), addiction, and PTSD.

The authors of this manuscript work at a busy neuromodulation center with active clinical trials in TMS, DBS, stereotactic ablation, and ECT. It has been our experience that providing a neuromodulatory option may not be enough to get patients better; the events preceding and following a psychiatric neuromodulation intervention may be just as important as the intervention itself. Prior to neuromodulation, patient selection as well as patient, caregiver and clinician expectations can significantly influence enrollment and success of the intervention. Following neuromodulation, the type and frequency of follow-up assessments, adjuvant therapies (i.e., psychotherapy), and referral of nonresponders for additional treatments may be a critical and underappreciated predictor of treatment outcome. Despite a growing literature on psychiatric neuromodulation, the topic of pre- and post-neuromodulation care is rarely addressed. To highlight this, we investigated the neuromodulation literature to quantitatively describe trends in the field, to ask the question: what has been the focus of clinical psychiatric neuromodulation research articles? We identify major gaps in the literature and discuss how future work in this burgeoning field can begin to close them.

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Authors and Affiliations

  1. Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    Benjamin Davidson, Daniel Zhengze Li, Ying Meng, Clement Hamani & Nir Lipsman

  2. Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    Benjamin Davidson, Ying Meng, Clement Hamani & Nir Lipsman

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  1. Benjamin Davidson
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  2. Daniel Zhengze Li
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  4. Clement Hamani
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Contributions

BD made substantial contributions to the conception and design of this work, as well as the acquisition, analysis, and interpretation of the data. He played a major role in drafting the work, and granted final approval of the version to be published. He agrees to be accountable for all aspects of the work. DL made substantial contributions to the acquisition, analysis, and interpretation of the data. He played a major role in drafting the work, and granted final approval of the version to be published. He agrees to be accountable for all aspects of the work. YM made substantial contributions to the acquisition, analysis, and interpretation of the data. She played a major role in drafting the work, and granted final approval of the version to be published. She agrees to be accountable for all aspects of the work. CH made substantial contributions to the acquisition, analysis, and interpretation of the data. He played a major role in drafting the work, and granted final approval of the version to be published. He agrees to be accountable for all aspects of the work. NL made substantial contributions to the conception and design of this work, as well as the acquisition, analysis, and interpretation of the data. He played a major role in drafting the work, and granted final approval of the version to be published. He agrees to be accountable for all aspects of the work.

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Correspondence to Nir Lipsman.

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There are no conflicts of interest to declare. The authors of this study are involved in employing the treatments discussed in this article, but have no financial stake in any of them.

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Davidson, B., Li, D.Z., Meng, Y. et al. Psychiatric neuromodulation: the underappreciated importance of pre- and post-treatment care. Mol Psychiatry 26, 366–369 (2021). https://doi.org/10.1038/s41380-020-0851-0

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