Treatment-resistant depression with poor response to deep brain stimulation improves with psychotherapy: case series

Deep brain stimulation (DBS) is regarded as an efficacious treatment for treatment-resistant depression (TRD), exhibiting a response rate of approximately 60%. However, certain patients exhibit limited responsiveness to DBS, necessitating further exploration of alternative interventions. In this paper, we present two cases of TRD patients who exhibited poor response to DBS surgery but showed significant improvement after receiving psychotherapy. In case 1, a 20-year-old female patient exhibited a slight initial positive response after DBS surgery; however, her symptoms continued to deteriorate progressively. Following systematic cognitive behavioral therapy (CBT), she demonstrated remarkable improvement in depressive symptoms. In case 2, a 36-year-old male patient experienced short-term symptomatic improvement post-DBS surgery but relapsed due to treatment interruption caused by financial constraints. After CBT intervention, the symptoms of his depression exhibited significant improvement. No previous studies have reported on the effects of CBT in postoperative depressive symptoms following DBS. The combination of DBS surgery and postoperative psychological therapy may enhance the therapeutic outcomes of DBS. This study emphasizes the significance of incorporating psychotherapy into the management after DBS surgery and calls for future research to further investigate the potential and mechanisms underlying this comprehensive treatment strategy.