Deep brain stimulation for treatment resistant depression: postoperative feelings of self-estrangement, suicide attempt and impulsive-aggressive behaviours

The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive-aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding patients with suicidality risk factors from DBS experimental trials – such as history of self-estrangement, suicide attempts and impulsive-aggressive inclinations- lead to minimizing the risk of suicidality harm?