Display options
Cite
Ward MP, Irazoqui PP. Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics. Front Neuroeng. 2010;3:7doi: 10.3389/fneng.2010.00007.
Ward, M. P., & Irazoqui, P. P. (2010). Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics. Frontiers in neuroengineering, 37. https://doi.org/10.3389/fneng.2010.00007
Ward, Matthew P, and Irazoqui, Pedro P. "Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics." Frontiers in neuroengineering vol. 3 (2010): 7. doi: https://doi.org/10.3389/fneng.2010.00007
Ward MP, Irazoqui PP. Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics. Front Neuroeng. 2010 May 31;3:7. doi: 10.3389/fneng.2010.00007. eCollection 2010. PMID: 20631824; PMCID: PMC2901135.
Copy Download .nbib Format: NLM
Share it on

Front Neuroeng. 2010 May 31;3:7. doi: 10.3389/fneng.2010.00007. eCollection 2010.

Evolving refractory major depressive disorder diagnostic and treatment paradigms: toward closed-loop therapeutics.

Frontiers in neuroengineering

Matthew P Ward, Pedro P Irazoqui

Affiliations

  1. School of Biomedical Engineering, Purdue University West Lafayette, IN, USA.

PMID: 20631824 PMCID: PMC2901135 DOI: 10.3389/fneng.2010.00007

Abstract

Current antidepressant therapies do not effectively control or cure depressive symptoms. Pharmaceutical therapies altogether fail to address an estimated 4 million Americans who suffer from a recurrent and severe treatment-resistant form of depression known as refractory major depressive disorder. Subjective diagnostic schemes, differing manifestations of the disorder, and antidepressant treatments with limited theoretical bases each contribute to the general lack of therapeutic efficacy and differing levels of treatment resistance in the refractory population. Stimulation-based therapies, such as vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation, are promising treatment alternatives for this treatment-resistant subset of patients, but are plagued with inconsistent reports of efficacy and variable side effects. Many of these problems stem from the unknown mechanisms of depressive disorder pathogenesis, which prevents the development of treatments that target the specific underlying causes of the disorder. Other problems likely arise due to the non-specific stimulation of various limbic and paralimbic structures in an open-loop configuration. This review critically assesses current literature on depressive disorder diagnostic methodologies, treatment schemes, and pathogenesis in order to emphasize the need for more stringent depressive disorder classifications, quantifiable biological markers that are suitable for objective diagnoses, and alternative closed-loop treatment options tailored to well-defined forms of the disorder. A closed-loop neurostimulation device design framework is proposed, utilizing symptom-linked biomarker abnormalities as control points for initiating and terminating a corrective electrical stimulus which is autonomously optimized for correcting the magnitude and direction of observed biomarker abnormality.

Keywords: closed-loop therapies; major depressive disorder; neurostimulation

References

  1. Acta Psychiatr Scand. 2007 Sep;116(3):174-81 - PubMed
  2. Am J Psychiatry. 1995 Mar;152(3):419-23 - PubMed
  3. Endocr Rev. 1996 Apr;17(2):187-205 - PubMed
  4. Psychopharmacology (Berl). 1981;75(4):368-71 - PubMed
  5. Biol Psychiatry. 2004 Sep 15;56(6):418-26 - PubMed
  6. Biol Psychiatry. 2009 Feb 15;65(4):267-75 - PubMed
  7. Epilepsy Res. 1995 Mar;20(3):221-7 - PubMed
  8. Proc Natl Acad Sci U S A. 2008 Apr 1;105(13):5105-10 - PubMed
  9. Biol Psychiatry. 2000 Oct 15;48(8):830-43 - PubMed
  10. Mt Sinai J Med. 2008 May-Jun;75(3):263-75 - PubMed
  11. N Engl J Med. 1999 May 13;340(19):1476-80 - PubMed
  12. Neuron. 2002 Mar 28;34(1):13-25 - PubMed
  13. Acta Psychiatr Scand Suppl. 2000;403:17-25 - PubMed
  14. N Engl J Med. 2008 Jan 17;358(3):252-60 - PubMed
  15. J Clin Endocrinol Metab. 2005 May;90(5):2522-30 - PubMed
  16. Arch Gen Psychiatry. 1998 Aug;55(8):694-700 - PubMed
  17. Am J Psychiatry. 2006 Jan;163(1):88-94 - PubMed
  18. Biol Psychiatry. 2003 Sep 1;54(5):499-503 - PubMed
  19. Am J Psychiatry. 1986 Jan;143(1):29-34 - PubMed
  20. J Psychiatr Res. 2007 Apr-Jun;41(3-4):326-31 - PubMed
  21. JAMA. 1989 Aug 18;262(7):914-9 - PubMed
  22. J Neuropsychiatry Clin Neurosci. 1997 Summer;9(3):471-81 - PubMed
  23. Lancet. 1999 Oct 30;354(9189):1526 - PubMed
  24. Biol Psychiatry. 2000 Feb 15;47(4):287-95 - PubMed
  25. J Neurosurg. 2004 Jun;100(6):1084-6 - PubMed
  26. J Clin Psychiatry. 1997;58 Suppl 13:23-9 - PubMed
  27. Am J Psychiatry. 2000 Oct;157(10):1552-62 - PubMed
  28. IEEE Trans Biomed Eng. 1997 Oct;44(10):931-9 - PubMed
  29. J Neurosci. 2004 Feb 11;24(6):1478-85 - PubMed
  30. J Comp Neurol. 1998 Nov 30;401(4):480-505 - PubMed
  31. Science. 1984 Dec 14;226(4680):1342-4 - PubMed
  32. Biol Psychiatry. 2003 Jul 1;54(1):70-5 - PubMed
  33. J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1713-6 - PubMed
  34. Med Hypotheses. 1991 Aug;35(4):298-306 - PubMed
  35. J Comp Neurol. 2004 Apr 19;472(1):113-29 - PubMed
  36. Am J Psychiatry. 1999 Jul;156(7):1000-6 - PubMed
  37. Acta Psychiatr Scand Suppl. 2007;(433):90-103 - PubMed
  38. Arch Gen Psychiatry. 2004 Jan;61(1):34-41 - PubMed
  39. Neuropsychopharmacology. 2000 Nov;23(5):477-501 - PubMed
  40. J Psychiatr Res. 2007 Nov;41(9):801-3 - PubMed
  41. N Engl J Med. 2008 Jan 3;358(1):55-68 - PubMed
  42. Mol Psychiatry. 2007 Apr;12(4):331-59 - PubMed
  43. Biol Psychiatry. 2006 Jun 15;59(12):1116-27 - PubMed
  44. Science. 2003 Jul 18;301(5631):386-9 - PubMed
  45. Am J Psychiatry. 1999 May;156(5):675-82 - PubMed
  46. J Neural Eng. 2007 Jun;4(2):L14-21 - PubMed
  47. Br J Psychiatry. 1982 Jul;141:45-9 - PubMed
  48. Arch Gen Psychiatry. 2001 Jul;58(7):631-40 - PubMed
  49. Int J Psychophysiol. 1994 Oct;18(1):49-65 - PubMed
  50. Psychiatry Res. 2002 Mar 15;109(2):143-8 - PubMed
  51. Neurotherapeutics. 2008 Jan;5(1):68-74 - PubMed
  52. J Clin Neurophysiol. 1991 Jan;8(1):102-11 - PubMed
  53. Neuropsychopharmacology. 2006 Jul;31(7):1345-55 - PubMed
  54. J Neurosci Methods. 2009 Jun 15;180(2):278-89 - PubMed
  55. Annu Rev Psychol. 2002;53:545-74 - PubMed
  56. Biol Psychiatry. 2006 Jan 15;59(2):187-94 - PubMed
  57. Arch Gen Psychiatry. 2008 Feb;65(2):190-200 - PubMed
  58. J Neurochem. 1996 Jun;66(6):2621-4 - PubMed
  59. Neuron. 2005 Mar 3;45(5):651-60 - PubMed
  60. J Neurosci. 1995 Nov;15(11):7539-47 - PubMed
  61. Epilepsia. 1998 Jul;39(7):709-14 - PubMed
  62. Acta Psychiatr Scand. 2002 May;105(5):324-40 - PubMed
  63. Neurosurgery. 2005 Sep;57(3):439-48; discussion 439-48 - PubMed
  64. Arch Gen Psychiatry. 2005 Jun;62(6):593-602 - PubMed
  65. Arch Gen Psychiatry. 2001 Jul;58(7):641-8 - PubMed
  66. Biol Psychiatry. 2000 Dec 15;48(12):1133-41 - PubMed
  67. Appl Neurophysiol. 1987;50(1-6):344-6 - PubMed
  68. Psychoneuroendocrinology. 2005 Oct;30(9):846-56 - PubMed
  69. Am J Psychiatry. 1997 Mar;154(3):426-8 - PubMed
  70. J Gen Intern Med. 2008 Jan;23(1):25-36 - PubMed
  71. Trends Immunol. 2006 Jan;27(1):24-31 - PubMed
  72. Ann N Y Acad Sci. 2000;917:478-87 - PubMed
  73. Neurosurgery. 2009 Jan;64(1):156-62; discussion 162-3 - PubMed
  74. J Clin Psychiatry. 2008 Feb;69(2):222-32 - PubMed
  75. World J Biol Psychiatry. 2007;8(3):141-74 - PubMed
  76. Clin Chem. 1974 Apr;20(4):470-5 - PubMed
  77. Neuropsychopharmacology. 2008 Jan;33(1):88-109 - PubMed
  78. Epilepsia. 1994 May-Jun;35(3):616-26 - PubMed
  79. Neurosurgery. 2005 Sep;57(3):585-93; discussion 585-93 - PubMed
  80. Biol Psychiatry. 2007 Apr 1;61(7):831-5 - PubMed
  81. N Engl J Med. 2005 Oct 27;353(17):1819-34 - PubMed
  82. Biol Psychiatry. 2002 Feb 15;51(4):280-7 - PubMed
  83. Mol Psychiatry. 2004 Apr;9(4):386-92 - PubMed
  84. Nat Rev Neurosci. 2008 Jan;9(1):46-56 - PubMed
  85. Mol Psychiatry. 2000 May;5(3):262-9 - PubMed
  86. Biol Psychiatry. 1994 Sep 1;36(5):292-9 - PubMed
  87. Am J Psychiatry. 2001 Mar;158(3):405-15 - PubMed
  88. Epilepsia. 1998 Sep;39(9):983-90 - PubMed
  89. J Am Geriatr Soc. 1954 Jul;2(7):456-66 - PubMed
  90. Br J Psychiatry. 1967 Nov;113(504):1237-64 - PubMed
  91. Biol Psychiatry. 2003 Apr 15;53(8):649-59 - PubMed
  92. Nat Med. 2001 May;7(5):541-7 - PubMed
  93. PLoS Med. 2005 Dec;2(12):e392 - PubMed
  94. J Neurosci Methods. 2009 Oct 15;183(2):267-76 - PubMed
  95. Gen Hosp Psychiatry. 1994 Jul;16(4):267-76 - PubMed
  96. Neuropsychopharmacology. 2006 Nov;31(11):2384-93 - PubMed
  97. Biol Psychiatry. 2000 Feb 15;47(4):276-86 - PubMed
  98. Biol Psychiatry. 2000 Oct 15;48(8):732-9 - PubMed
  99. Biol Psychiatry. 1997 Jan 15;41(2):196-200 - PubMed
  100. Arch Gen Psychiatry. 2000 Oct;57(10):925-35 - PubMed
  101. Am J Psychiatry. 2000 Feb;157(2):229-33 - PubMed
  102. J Psychiatr Res. 1986;20(3):211-6 - PubMed
  103. Arch Gen Psychiatry. 1997 Jul;54(7):597-606 - PubMed
  104. J Gen Intern Med. 2001 Sep;16(9):606-13 - PubMed
  105. Arch Gen Psychiatry. 2005 Apr;62(4):397-408 - PubMed
  106. J Neuropsychiatry Clin Neurosci. 1998 Winter;10(1):20-5 - PubMed
  107. Am J Psychiatry. 1980 Jul;137(7):782-90 - PubMed
  108. J Pers Soc Psychol. 1992 Apr;62(4):676-87 - PubMed
  109. Neurosci Biobehav Rev. 2009 Jul;33(7):1042-60 - PubMed
  110. Arch Gen Psychiatry. 1999 Apr;56(4):315-20 - PubMed
  111. Biol Psychiatry. 2008 Sep 15;64(6):461-7 - PubMed
  112. Lancet. 1985 May 11;1(8437):1106-7 - PubMed
  113. PLoS Med. 2008 Feb;5(2):e45 - PubMed
  114. Arch Gen Psychiatry. 1987 Apr;44(4):328-36 - PubMed
  115. JAMA. 2003 Jun 18;289(23):3095-105 - PubMed
  116. Biol Psychiatry. 2005 Sep 1;58(5):364-73 - PubMed
  117. Arch Gen Psychiatry. 2005 May;62(5):529-35 - PubMed
  118. Biol Psychiatry. 2009 Feb 15;65(4):263-6 - PubMed

Publication Types