INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY

Int J Geriatr Psychiatry 2005; 20: 1205.

BOOK REVIEW

Brain Stimulation in Psychiatric Treatment. Edited byS. H. Lisanby. Review of Psychiatry Series, Volume23. Series Editors J. M. Oldham, M. B. Riba Ameri-can Psychiatric Association, Washington DC, 2004.Pages: 153. Price. £25.95

The era of effective treatment of psychiatric disorderswith a physical therapy started 70 years ago with elec-troconvulsive therapy (ECT). It is intriguing that anew generation of brain stimulation techniques areonce again seen as being at the cutting edge of psy-chiatric treatment. ECT is still with us but remainsproblematic, something of a blunt instrument (albeita strikingly effective one) and is declining in use.The resurgence in interest in brain stimulation isdue to the rapid recent advances in neuroscienceand in our understanding of the functional neuroanat-omy of the brain. In spite of this, our ability to targetabnormalities in brain circuitry to relieve mental dis-orders remains an unachieved Holy Grail. This booksets out to describe progress in the Quest so far. If youare looking for answers you are likely to be disap-pointed, it is not yet clear which, if any, of the techni-ques described will pass into routine psychiatricpractice, let alone revolutionise the field in the waythat ECT did.

This book is part of the well-known Review of Psy-chiatry series in which experts are commissioned toreview and summarise areas of current interest andexcitement. Surprisingly ECT itself is not reviewedin spite of ongoing research into different waveformsand methods of delivery that may allow improve-ments in adverse effects. Apart from a brief overviewin the introduction, the five chapters are verymuch stand alone in covering their respective areas.

Transcranial magnetic stimulation (TMS), the leastinvasive technique, is given two chapters reflectingthe wide range of disorders in which it has been tried(from depression to schizophrenia). More invasivetreatments are magnetic seizure therapy (MST), as apossible ‘better’ version of ECT, deep brain stimula-tion (DBS) and vagus nerve stimulation (VNS). Thelatter two are in use for neurological disorders suchas Parkinson’s disease and epilepsy.

As might be expected, the authors are enthusiastsfor the treatments they describe. Nevertheless, at leastfor psychiatric disorders, the bottom line for all ofthem is caution about the lack of definitive efficacydata, problems in knowing the optimum treatmentparameters and uncertain clinical utility. The techni-ques are well described and the book offers an acces-sible introduction to, and overview of, the field forthose wanting to be abreast of developments and toanswer the queries of ever more informed patients.However, it is very much work in progress and notdirectly relevant to most clinicans or their patients.It is a shame that there is no chapter on recent researchinto ECT. After all, this is the brain stimulation tech-nique that patients are currently exposed to routinelyand which is desperately in need of good qualityresearch.

IAN ANDERSON

Senior Lecturer in PsychiatryNeuroscience and Psychiatry Unit

The University of ManchesterManchester, UK

Published online in Wiley InterScience(www.interscience.wiley.com).

DOI: 10.1002/gps.1415

Copyright # 2005 John Wiley & Sons, Ltd.