“Getting physical”: the management of neuropsychiatric disorders using novel physical treatments

Gin S Malhi^1,2, Colleen Loo^1,2, Catherine M Cahill^1,2, Jim Lagopoulos^1,2,4, Philip Mitchell^1,2, Perminder Sachdev^1,3

¹School of Psychiatry, University of New South Wales, Australia; ²Mood Disorders Unit, Black Dog Institute, Australia; ³Neuropsychiatric Institute, Prince of Wales Hospital, Australia; ⁴Department of Neurology, Westmead Hospital, Australia

Objective: To summarize and review the utility of physical interventions in the treatment of psychiatric disorders.

Methods: A systematic review of the literature pertaining to novel physical interventions, namely, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation, and neurosurgery, was conducted using MEDLINE, EMBASE, and PSYCHLIT. Bibliographies of papers were scrutinized for further relevant references along with literature known to the authors.

Results: Currently available physical interventions worldwide are reviewed with respect to efficacy, applications, and putative indications. Physical interventions have experienced a resurgence of interest for both the investigation of brain function and the treatment of neuropsychiatric disorders. The widespread availability of neuroimaging technology has advanced our understanding of brain function and allowed closer examination of the effects of physical treatments. Clinically, transcranial magnetic stimulation seems likely to have a role in the management of depression, and its use in other neuropsychiatric disorders appears promising. Following on from its success in the management of intractable epilepsy, vagus nerve stimulation is undergoing evaluation in the treatment of depression with some success in refractory cases. Deep brain stimulation has improved mood in patients with Parkinson’s disease and may also relieve symptoms of obsessive-compulsive disorder. Neurosurgery has re-invented itself by way of increased technical sophistication, and although further assessment of its efficacy and clinical utility is still needed, its widespread practice reflects its increasing acceptance as a viable treatment of last resort.

Conclusion: It is clear that physical treatments are here to stay and “getting physical” offers a useful addition to the neuropsychiatrist’s therapeutic armamentarium. However, like all new treatments these interventions need to remain under rigorous scientific scrutiny to determine accurately their immediate and long-term effects.

Keywords: physical treatments, psychosurgery, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, neuropsychiatry