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Personal and relational changes following deep brain stimulation for treatment-resistant depression: A prospective qualitative study with patients and caregivers

journal contribution
posted on 2023-05-21, 17:26 authored by Cassandra ThomsonCassandra Thomson, Segrave, RA, Fitzgerald, PB, Richardson, KE, Racine, E, Carter, A

Objective: Deep brain stimulation (DBS) and whether it alters patient personality is a much-debated topic within academic literature, yet rarely explored with those directly involved. This study qualitatively examined how DBS for treatment-resistant depression impacts patient personality, self-concept, and relationships from the perspectives of both patients and caregivers.

Methods: A prospective qualitative design was used. Eleven participants were included (six patients, five caregivers). Patients were enrolled in a clinical trial of DBS of the bed nucleus of the stria terminalis. Semi-structured interviews were conducted with participants before DBS-implantation and 9-months after stimulation-initiation. The 21 interviews were thematically analysed.

Results:Three primary themes were identified: (a) impact of mental illness and treatment on self-concept; (b) device acceptability and usability, and (c) relationships and connection. Severe refractory depression had profoundly impacted who patients were, how they viewed themselves, and the quality and functioning of their relationships. Patients who benefited from DBS felt reconnected with their premorbid self, yet still far from their ideal self. While reductions in depression were broadly beneficial for relationships, the process of adjusting relationship dynamics created new challenges. All patients reported recharging difficulties and challenges adapting to the device.

Conclusions: Therapeutic response to DBS is a gradual and complex process that involves an evolving self-concept, adjusting relationship dynamics, and growing connection between body and device. This is the first study to provide in-depth insight into the lived experience of DBS for treatment-resistant depression. Patient and caregiver narrative accounts should be routinely collected to guide more person-centred DBS clinical interventions.

History

Publication title

PLoS ONE

Volume

18

Issue

4

Article number

0284160

Number

0284160

Pagination

1-18

ISSN

1932-6203

Department/School

Wicking Dementia Research Education Centre

Publisher

Public Library of Science

Place of publication

San Francisco, CA

Repository Status

  • Restricted

Socio-economic Objectives

Treatment of human diseases and conditions; Mental health