Barriers and facilitators to implementing deep brain stimulation for psychiatric disorders: a systematic review

BACKGROUND: Deep brain stimulation (DBS) is effective in treating severe obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). However, patient referrals for DBS remain lower than expected based on prevalence and eligibility. Understanding the factors behind this gap is crucial for improving DBS implementation. This study aimed to identify key barriers and facilitators influencing DBS use for OCD and TRD. Insights from this research may help policymakers and clinicians address challenges, ultimately enhancing DBS accessibility and effectiveness for psychiatric disorders. METHODS: A systematic review was performed using four electronic databases until May 1st 2024 following PRISMA and ENTREQ guidelines. Eligible for inclusion were quantitative and qualitative studies describing facilitators or barriers for implementing DBS in psychiatry. RESULTS: We included 28 studies, out of which 11 in TRD, 5 in OCD and 12 in both, and revealed a spectrum of barriers, including ethical concerns, safety issues, stigma and knowledge gaps. Promising facilitators include educational initiatives, specialized psychiatric DBS care and stakeholder engagement. DISCUSSION: This first systematic review provides a comprehensive overview of barriers and facilitators affecting DBS implementation for OCD and TRD. Key areas include establishing consensus on treatment resistance, refining referral guidelines, addressing knowledge gaps among clinicians-such as psychiatrists unfamiliar with neurosurgical psychiatric treatments-and improving DBS's media image to reduce stigma. Limitations include a large portion of included articles from the same contributors and a predominance of US-based studies, potentially affecting generalizability of findings. International perspectives should be included in future studies to ensure a more widely applicable understanding of DBS implementation challenges.