These are currently being revised (November 2014). Please revisit this page for the latest version.
As a guiding principle, all of the physical treatments that have been shown to be effective in ‘treatment-resistant-depression’ (preferably in randomised, controlled trials) must have been tried in adequate dosage for an adequate period. In general terms, this will reflect the prescription of antidepressant drugs within, or above, the dose range recommended by the British National Formulary (BNF) for a period of at least six weeks.
It is important to note that a proportion of individuals with chronic, refractory depression will have unrecognised or ‘undeclared’ Bipolar Disorder. Therefore, the following also considers the application of “bipolar depression” treatment strategies as part of the framework for treatment ‘adequacy’ prior to ablative NMD.
At present, the use of plasma drug concentration monitoring (where possible) is not included as a mandatory requirement, but is sometimes desirable. Most patients referred for assessment will have been exposed to many different treatment trials. The following represent those deemed ‘essential’ before proceeding to ablative surgery.
The minimum inclusion criteria for neurosurgery are:
Desirable but not essential prior to ablative NMD. Either: an absence of unequivocal evidence of efficacy in TRD, or, only suitable for selected patients on the basis of increased risk to physical health: