Neurosurgery for mental disorder (NMD)

Neurosurgery for mental disorder (NMD) is rare and there's still a lot we don't know about it.

If a doctor suggests it, it's usually because you've tried a lot of other treatments that haven't worked. This can feel very lonely and confusing.

We're here to help you understand what NMD is, the risks and benefits, and your rights.

What is NMD?

Neurosurgery for mental disorder (NMD) is a type of brain surgery. Its aim is to destroy small areas of your brain that might cause mental health problems. It’s very rare for doctors to offer it in England and Wales.

There are two main types of NMD. These are called 'anterior cingulotomy' and 'anterior capsulotomy'. They target slightly different parts of the brain. You can't reverse them once you've had surgery.

There are alternatives to NMD, such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS).

What can NMD treat?

The National Institute for Health and Care Excellence (NICE) doesn't recommend NMD to treat any mental health problems. This is because there is not enough evidence about how safe or effective it is.

But in very rare cases, doctors may consider using NMD to treat severe treatment-resistant:

• Depression
• Obsessive-compulsive disorder (OCD)

'Treatment-resistant' means you’ve tried all other treatments and they haven’t worked. This is likely to include treatments like talking therapies and medication. It may also include less common treatments, like electroconvulsive therapy (ECT).

Doctors should only suggest NMD if you've tried these other options and they haven’t helped. This is because there are very serious risks with having NMD.

What are the side effects of NMD?

Before you agree to the procedure, doctors should explain the possible side effects of NMD and how likely you are to experience them.

Some side effects might go away or get better over time. Others might last for longer.

Side effects of NMD can include:

• Headache or nausea
• Hallucinations or confusion (our psychosis page has information about hallucinations)
• Memory or concentration problems
• Sleep problems or tiredness
• Loss of bladder or bowel control
• Seizures
• Brain cysts or oedema (swelling or fluid in the brain)
• Weight gain

You may also experience suicidal feelings or changes in your personality when having NMD. If you’re worried about this, speak to your doctor or psychiatrist.

Does NMD work?

It's difficult to know how well NMD works, because so few people have it. And there are different ways to perform it, which are hard to compare.

NMD is not a cure for mental health problems. But some studies suggest that it may reduce the intensity of the symptoms of some mental health problems when other treatments haven't helped. These include severe depression and obsessive-compulsive disorder (OCD).

Researchers don’t know exactly how long these benefits last. But you can usually tell if your treatment has worked within 6 to 12 months of having surgery.

Can doctors perform NMD without my consent?

No. In England and Wales doctors can’t give you NMD without your consent.

This is also true if you don’t have the mental capacity to make this decision. Doctors can't use the Mental Capacity Act to allow NMD. This is because NMD is covered by section 57 of the Mental Health Act.

See our pages on consent to treatment for more information on giving consent for mental health treatments.

How do I decide whether to have NMD?

It’s very rare for doctors to offer NMD. But if they do, you have choices.

It’s important to think about the risks and benefits. So you could try asking some of these questions to learn more:

• Why have you suggested NMD?
• Could NMD make me feel worse?
• What are the risks and side effects of NMD?
• Have you offered me every other available treatment?
• What treatments will you offer me after having NMD?
• What will happen when I go into hospital for NMD?
• How long will it take me to recover from NMD surgery?
• If NMD works, when will I feel better?

You could also ask someone you trust, or an advocate, to ask these questions for you.