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Surgical Options for Severe Mental Disorders: NMD│ DBS │ VNS

In most cases, when we think of mental illness treatments, we think of conservative solutions. Psychiatric therapy and medications are two of the most common treatment approaches followed for managing mental disorders.

The lack of awareness about the surgical treatments of these conditions can often make patients nervous about undergoing it, preventing them from living a normal life.  

Psychosurgery/ Neurosurgery for Mental Disorders (NMD)

Neurosurgery for mental disorders (NMD) is a form of brain surgery used for treating patients with severe and incapacitating psychological illnesses who have not received relief from other treatments. NMD is commonly used for treating or managing the obsessive-compulsive disorder and severe depression.

During Psychosurgery, certain tissues are removed or disconnected from the brain with the intent of altering the cognitive and affective states caused due to various mental illnesses.

Neurosurgery for mental illnesses is performed very rarely, which makes it difficult for medical professionals and researchers to determine its effectiveness. Use of different surgical techniques and approaches in each case also makes it hard to analyze the results.

NMD is not performed in several countries because of the lack of evidence around its safety and effectiveness, but some people have been successfully treated after this treatment, while a small percentage has experienced brain damage.

Neurosurgery for mental illness is also a non-reversible treatment; any damage occurred during the procedures becomes permanent.  

ALTERNATIVE TREATMENTS OF NMD

Deep brain stimulation (DBS)

What is DBS?

Deep Brain Stimulation is also a brain surgery; however, unlike NMD, it can be reversed. DBS is used for treating:

  • severe depression that hasn’t improved by other treatments
  • untreated long-term OCD
  • movement disorders like Parkinson’s disease

The healthcare organizations across the globe have produced clinical guidelines for using DBS as a Parkinson’s disease treatment, but not for OCD or depression. This is because no evidence was found in studies that DBS is effective in treating these mental health illnesses.

How does DBS work?

Deep Brain Stimulation surgery may be performed using a general or local anaesthetic. Then electrodes are implanted in the patient’s brain using a stereotactic frame. These electrodes are insulated wires which conduct electricity, but, instead of destroying the inner cells, these electrodes are left in place and used for stimulating small areas of the patient’s brain.

Wires are implanted just beneath the patient’s skin from their brain to a stimulator (designed similar to a pacemaker), that is placed in their chest wall, and is programmed for delivering continuous electric stimulation.

With both OCD and depression, the patient may find DBS very helpful when the stimulation is turned on, but they may experience similar problems if it is switched off.

Possible side effects of Deep Brain Stimulation are:

  • Infection on the incision site post-surgery
  • complications with the equipment, for instance, if the stimulator becomes damaged or face any other problems
  • complications due to surgery like seizures or bleeding in the brain
  • hypomania
  • an increase in the aggressiveness of the symptoms of anxiety and depression

In some rare cases, patients have reported experiencing suicidal thoughts and feelings after undergoing DBS. However, it is not clear whether these thoughts are caused because of the surgery itself or because of the mental health illness.

Also, patients with DBS implants cannot receive electroconvulsive therapy (ECT).

Vagus Nerve Stimulation (VNS)

What is VNS?

Vagus Nerve Stimulation is also used in rare cases for treating:

  • Epilepsy, a form of neurological disorder in patients experience intense seizures
  • severe depression that has not improved from other treatments

Some researches in the past decade show that VNS can be helpful in reducing the severe depression symptoms that haven’t improved from other treatments.

But due to lack of treatment, it is only recommended in critical cases, and are performed by specialized surgeons.

How does VNS work?

In Vagus Nerve Stimulation surgery, a generator type device is implanted inside the chest, with the electrodes that are connected to the vagus nerve in the patient’s neck area. The device then sends timed pulses to the vagus nerve, that has branches across multiple organs of the patient’s body to the brain. The operation can be performed using a local or general anaesthetic.

VNS’s Possible Side Effects

  • headaches
  • coughing
  • neck pain
  • changes in the patient’s voice
  • sore throat
  • difficulty in breathing

Reducing the intensity of the electrical pulses produced from the generator implanted in the chest helps in reducing the side effects experienced in the illness.

Where is VNS performed?

VNS is more widely performed than DBS, but it is still offered by only a few experienced specialists. VNS is performed for treating epilepsy, so it is usually available at most neurology and mental health hospitals in India.

Note: Surgical treatment does not guaranty permanent cure; they are performed in severe cases. Patients are likely to be recommended to get continued psychiatric support post-surgery, even if the operation is considered successful.

We also suggest patients receive multiple opinions before undergoing surgeries for mental illnesses. Brain surgery is a very complicated procedure which should be performed by a highly experienced surgeon.

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