Ethical issues in experimental treatments for psychiatric disorders: Lessons from deep brain stimulation

Experimental trials of deep brain stimulation (DBS) are occurring worldwide for a variety of psychiatric disorders, including depression and obsessive–compulsive disorder, and to a lesser extent substance use disorders and anorexia nervosa. DBS is a neurosurgical procedure that comes with serious risks and the relative benefits for psychiatric indications are still being determined. The application of DBS in psychiatric populations raises a number of ethical challenges that research teams need to consider and manage. Here we highlight a number of pertinent issues and recommendations, many of which were relevant in our interviews with DBS patients, caregivers and clinicians on their perspectives and experiences. Given psychiatric DBS trials are both experimental and resource-heavy, careful patient selection is required. Independent oversight is recommended in the recruitment process. Disorder-related cognitive and emotional factors need to be considered during informed consent, with a process structured to promote and assess comprehension. Patients, families and clinical teams need to have an awareness and understanding of surgical and stimulation-related risks, which can have both short and long-term implications. Patients and families are often desperate for a cure and may be persuaded to undergo DBS by media portrayals of “miracle cures.” Research teams therefore need to be mindful of unrealistic expectations and take steps to ensure the media is balanced in their reporting of trial results. As a potentially lifelong treatment, DBS raises important questions regarding medical, financial, and legal responsibility. For this reason, ethically rigorous posttrial management plans between patients and research teams are recommended.