Brain Stimulation

Brain stimulation therapies (Neurostimulation, neuromodulation) are a type of intervention used to treat psychiatric and neuropsychiatric disorders. Neurostimulation involve activating or inhibiting the areas of the brain directly via electricity or magnetic stimulus. The electricity can be delivered in various ways, including via electrodes implanted in the brain (e.g. - deep brain stimulation), or non-invasively through electrodes on the scalp (e.g. - electroconvulsive therapy).

The most common types of neurostimulation treatments include noninvasive techniques, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), and magnetic seizure therapy (MST). Invasive surgical techniques, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS) are also treatment modalities. Most neurostimulation treatments are used in patients with treatment-resistant depression who have failed to respond to traditional treatments.

Neurostimulation in the Treatment of Major Depressive Disorder

Milev, R. V. et al. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry, 61(9), 561-575.
Neurostimulation Overall Recommendation Acute Efficacy Maintenance Efficacy Safety and Tolerability
rTMS • First line (for patients who have failed at least 1 antidepressant) Level 1 Level 3 Level 1
ECT • Second line
• First line in some acute clinical situations
Level 1 Level 1 Level 1
tDCS • Third line Level 2 Level 3 Level 2
Vagal Nerve Stimulation (VNS) • Third line Level 3 Level 2 Level 2
DBS • Investigational Level 3 Level 3 Level 3
MST • Investigational Level 3 Not known Level 3
For Providers