{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:53:30Z","timestamp":1790618010602,"version":"4.1.0"},"reference-count":19,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T00:00:00Z","timestamp":1748131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a widely used intervention for Parkinson\u2019s disease (PD) and obsessive-compulsive disorder (OCD). While motor and OCD symptom benefits are established, increasing evidence highlights psychiatric side effects. The underlying mechanisms involve stimulation parameters, electrode positioning, and medication adjustments. This systematic review aims to evaluate the short-term and long-term psychiatric effects of STN-DBS and identify influencing factors. Methods: A systematic literature search (PubMed, Scopus, Web of Science, Embase; 2015\u20132024) was conducted following PRISMA guidelines. Studies examining psychiatric effects of STN-DBS in PD or OCD, reporting quantitative\/qualitative psychiatric measures, and specifying stimulation parameters were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs). Results: A total of 16 studies met the inclusion criteria, with sample sizes from 10 to 149 patients and short- to long-term follow-ups (up to 17 years). Short-term effects included transient hypomania, euphoria, increased impulsivity (especially with medial STN stimulation), and sometimes anxiety reduction. Long-term effects showed a tendency towards apathy and depression (apathy increased significantly in one large cohort), particularly linked to ventromedial STN stimulation or dopaminergic medication reduction. Impulse control disorders (ICDs) improved long-term in one study following medication reduction, while impulsivity slightly worsened in another. Verbal fluency decline was commonly reported, though global cognition often remained stable. Psychiatric outcomes (mood\/apathy, attention\/memory) depended on stimulation location within STN subregions. Higher total electrical energy delivered (TEED) correlated with depressive trait shifts in one study. Conclusions: STN-DBS has complex psychiatric consequences. Electrode positioning, stimulation parameters (including location within STN subregions and possibly TEED), and medication adjustments significantly influence outcomes. Careful patient selection, preoperative psychiatric screening, optimized programming targeting specific STN subregions, and cautious medication management are essential to minimize psychiatric risks while maximizing therapeutic benefits for motor and OCD symptoms.<\/jats:p>","DOI":"10.3390\/brainsci15060566","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T20:39:36Z","timestamp":1748205576000},"page":"566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Psychiatric Outcomes of Subthalamic Nucleus Deep Brain Stimulation: A Systematic Review of Short- and Long-Term Effects"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0642-4683","authenticated-orcid":false,"given":"Mattia Vittorio","family":"Pomes","sequence":"first","affiliation":[{"name":"Section of Psychiatry, Department of Neuroscience, Reproductive and Dental Sciences, University of Naples Federico II, 80131 Naples, Italy"},{"name":"Department of Mental Health and Addiction, Psychiatric Service of Diagnosis and Care-ASL Rome 5, 00019 Tivoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5156-658X","authenticated-orcid":false,"given":"Giordano","family":"D\u2019Urso","sequence":"additional","affiliation":[{"name":"Section of Psychiatry, Department of Neuroscience, Reproductive and Dental Sciences, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Bove","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive, Division of Neurosurgery, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Maria","family":"Cavallo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive, Division of Neurosurgery, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Della Ragione","sequence":"additional","affiliation":[{"name":"Section of Psychiatry, Department of Neuroscience, Reproductive and Dental Sciences, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4196-2456","authenticated-orcid":false,"given":"Carmela","family":"Palmiero","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive, Division of Neurosurgery, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Perrotta","sequence":"additional","affiliation":[{"name":"Section of Psychiatry, Department of Neuroscience, Reproductive and Dental Sciences, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive, Division of Neurosurgery, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-1607","authenticated-orcid":false,"given":"Teresa","family":"Somma","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Reproductive, Division of Neurosurgery, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1136\/jnnp-2017-316373","article-title":"Subthalamic stimulation and neuropsychiatric symptoms in Parkinson\u2019s disease: Results from a long-term follow-up cohort study","volume":"89","author":"Abbes","year":"2018","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000445076","article-title":"Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson\u2019s Disease: Association with Clinical Outcomes and Neuroanatomical Correlates","volume":"94","author":"Abulseoud","year":"2016","journal-title":"Ster. Funct. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1212\/WNL.0000000000012246","article-title":"Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients with Parkinson Disease","volume":"97","author":"Bove","year":"2021","journal-title":"Neurology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1136\/jnnp-2020-323421","article-title":"Deep brain stimulation of the subthalamic nucleus in obsessive\u2013compulsives disorders: Long-term follow-up of an open, prospective, observational cohort","volume":"91","author":"Chabardes","year":"2020","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e30698","DOI":"10.1016\/j.heliyon.2024.e30698","article-title":"Mixed anxiety-depressive disorder in Parkinson\u2019s disease associated with worse resting state functional response to deep brain stimulation of subthalamic nucleus","volume":"10","author":"Filip","year":"2024","journal-title":"Heliyon"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"166","DOI":"10.2176\/nmc.oa.2016-0114","article-title":"Predictive Factors for Long-term Outcome of Subthalamic Nucleus Deep Brain Stimulation for Parkinson\u2019s Disease","volume":"57","author":"Fukaya","year":"2017","journal-title":"Neurol. Med. Chir."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/cns.13713","article-title":"Eight-year follow-up outcome of subthalamic deep brain stimulation for Parkinson\u2019s disease: Maintenance of therapeutic efficacy with a relatively low levodopa dosage and stimulation intensity","volume":"27","author":"Jiang","year":"2021","journal-title":"CNS Neurosci. Ther."},{"key":"ref_8","first-page":"1681","article-title":"Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson\u2019s Disease: A 5-year Follow-up Study in China","volume":"129","author":"Jiang","year":"2016","journal-title":"Chin. Med. J."},{"key":"ref_9","first-page":"1327","article-title":"Energy Delivered by Subthalamic Deep Brain Stimulation for Parkinson Disease Correlates with Depressive Personality Trait Shift","volume":"25","author":"Mameli","year":"2022","journal-title":"Neuromodulation"},{"key":"ref_10","first-page":"672","article-title":"The Impact of Subthalamic Deep Brain Stimulation on Apathy in Parkinson\u2019s Disease Patients","volume":"34","author":"Oner","year":"2024","journal-title":"Turk. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3592","DOI":"10.1093\/brain\/awz285","article-title":"Non-motor outcomes depend on location of neurostimulation in Parkinson\u2019s disease","volume":"142","author":"Krause","year":"2019","journal-title":"Brain"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/s41398-019-0404-y","article-title":"Affective modulation of the associative-limbic subthalamic nucleus: Deep brain stimulation in obsessive\u2013compulsive disorder","volume":"9","author":"Polosan","year":"2019","journal-title":"Transl. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/s41531-024-00701-6","article-title":"Predictors of short-term anxiety outcome in subthalamic stimulation for Parkinson\u2019s disease","volume":"10","author":"Sauerbier","year":"2024","journal-title":"npj Park. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Somma, T., Esposito, F., Scala, M.R., Scelzo, A., Baiano, C., Patti, S., Meglio, V., Iasevoli, F., Cavallo, L.M., and Solari, D. (2022). Psychiatric Symptoms in Parkinson\u2019s Disease Patients before and One Year after Subthalamic Nucleus Deep Brain Stimulation Therapy: Role of Lead Positioning and Not of Total Electrical Energy Delivered. J. Pers. Med., 12.","DOI":"10.3390\/jpm12101643"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1038\/s44220-024-00289-z","article-title":"Modeling impulsivity and risk aversion in the subthalamic nucleus with deep brain stimulation","volume":"2","author":"Voon","year":"2024","journal-title":"Nat. Ment. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1017\/S1092852924000439","article-title":"Can total electrical energy (TEED) after subthalamic DBS alter verbal fluency in Parkinson\u2019s disease patients? A preliminary evidence","volume":"29","author":"Ruggiero","year":"2024","journal-title":"CNS Spectr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"eRW0182","DOI":"10.31744\/einstein_journal\/2024RW0182","article-title":"Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson\u2019s disease: A systematic review","volume":"22","author":"Lellis","year":"2024","journal-title":"Einstein"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Trenado, C., Boschheidgen, M., N\u2019diaye, K., Schnitzler, A., Mallet, L., and Wojtecki, L. (2023). No effect of subthalamic deep brain stimulation on metacognition in Parkinson\u2019s disease. Sci. Rep., 13.","DOI":"10.1038\/s41598-022-26980-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/6\/566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:40:07Z","timestamp":1760031607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/6\/566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,25]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["brainsci15060566"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15060566","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,25]]}}}