Neuromodulation – ECT, rTMS, DBS. In: Helmchen H, Sartorius N, editors. Ethics in Psychiatry. Dordrecht: Springer Netherlands; 2010. pp. 299-320. [DOI: 10.1007/978-90-481-8721-8_19]

Meditation-based lifestyle modification in mild to moderate depression-A randomized controlled trial

OBJECTIVE

Depression is a global key challenge in mental health care. The implementation of effective, low-risk and cost-effective interventions to reduce its disease burden is a necessity. The aim of this study was to investigate the efficacy of the new Meditation-Based Lifestyle Modification (MBLM) program, a "second-generation" mindfulness-based intervention, in depressive outpatients.

METHODS

Eighty-one patients with mild to moderate depression were randomized into three groups: intervention group (MBLM), control group (CONTROL), and treatment as usual group (TAU). The primary outcome was the change of depressive symptoms as administered by the Beck Depression Inventory-II (BDI-II) after 4 and 8 weeks. Secondary outcome variables included the Brief Symptom Checklist-18 and the Perceived Stress Scale-10. A 6-month follow-up was conducted.

RESULTS

A greater reduction of depressive symptoms was found in MBLM participants compared to CONTROL (p < .001, η_p²  = 0.11, d = 0.70) and TAU ( p<.001,ηp2=0.10,d=0.67$p\lt .001,{\eta }_{{\rm{p}}}^{2}=0.10,d=0.67$ ) with a 13.15 points reduction of BDI-II score versus 1.71 points (CONTROL) and 3.34 points (TAU) after 8 weeks. Between-group post hoc tests for all secondary outcomes and at follow-up also yielded significant between-group differences with medium to large effect sizes in favor of MBLM.

CONCLUSIONS

Study results showed beneficial effects of MBLM in depressed outpatients. Further high-quality controlled clinical studies including qualitative research are needed to investigate the specific and unspecific effects of the MBLM program in depression and other medical conditions.

[New indications for deep brain stimulation: ethical criteria for research and therapy]

The applications of deep brain stimulation (DBS) are rapidly increasing and now include a large variety of neurological and psychiatric diseases, such as depression, obsessive compulsive disorders, addiction, Alzheimer's disease, anorexia nervosa and rare movement disorders. These new applications confer a huge therapeutic potential in diseases for which often no treatment exists or which are refractory to existing therapies. This spread of applications, however, implies ethical problems in several domains: clinical use, research and presentation in the media and public. Thus, a systematic ethical analysis is needed to inform and guide this process. In this article we identify ethical problems involved in research and clinical use of novel DBS applications, suggest criteria and distinctions for structuring the ethical analysis, and articulate ethical demands for DBS research of novel applications.