Complications and Ethical Challenges in Neurosurgery for Psychiatric Disorders

Functional neurosurgery has emerged as a potential therapeutic option for patients with severe, treatment-resistant psychiatric disorders such as obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Among the most studied interventions, deep brain stimulation (DBS) has shown promising outcomes in open-label studies, though controlled trials have yielded more modest results. This discrepancy, along with concerns about surgical risks, neuropsychiatric side effects, and ethical challenges, has limited the broader implementation of psychiatric neurosurgery. This review explores the clinical complications of DBS-including vascular events, infections, and hardware-related issues-as well as cognitive and behavioral changes such as hypomania, apathy, and impulse control disorders. Ethical concerns are also addressed, including the difficulty of obtaining truly informed consent and the potential impact on personal identity. The article emphasizes the need for multidisciplinary teams, dynamic consent models, standardized protocols, and high-quality clinical trials to ensure safe, ethical, and effective use of neurosurgical interventions in psychiatry. Ultimately, the responsible integration of functional neurosurgery into psychiatric care requires not only technical precision but also ethical rigor and patient-centered collaboration.