Abstract

Background: Bipolar disorder (BD) is a chronic debilitating illness associated with socioeconomic burdens on patients and their caregivers. Presenting a challenge to diagnose, the management of bipolar disorder with existing first-line pharmacologic and psychological therapies has not yielded much significant results. As a result, there is the need to explore other more efficacious modalities of treatment of the condition. This systematic review analyzes the efficacy of deep brain stimulation (DBS), a novel neuropsychosurgical intervention, in managing bipolar disorder, with specific focus on neuroanatomical and neurophysiological circuitries involved in the pathophysiology of bipolar disorder.

Methods: A search of online databases was conducted using the following keywords: deep brain stimulation, bipolar disorder, mania, depression, and treatment. Articles selected for use included those which have been peer-reviewed, and contained either case reports, case series, open-label, single-blind, and randomized double-blind sham-controlled studies.

Results: Significant evidence supports the increased use of DBS in bipolar depression, with a reduced risk of triggering mania in bipolar depressed patients. Low-quality evidence also suggests increased positive response in manic patients with bipolar disorder. There is minimal information in medical literature relating to acute adverse effects associated with the use of DBS in bipolar disorder. However, there is a dearth of evidence concerning what happens to patients in terms of relapse, response, or remission, years after cessation of stimulation.

Conclusion: The use of DBS in patients with BD requires a lot more exploration. However, present evidence shows that it is effective for patients with bipolar depression. Its use in manic individuals has not been well elucidated. Further research should explore its efficacy in manic individuals; and especially how to further refine the approach in order to increase efficacy and reduce the risk of adverse events in patients with bipolar disorder.

Keywords: Bipolar disorder, deep brain stimulation, mania, depression, unipolar depression.

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