Neurosurgery for mental disorder (NMD)

Explains what NMD is, what the operation is like, possible side effects and alternative surgical treatments. Also covers the law around consent to treatment by NMD.

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What is NMD?

Neurosurgery for mental disorder (NMD) is the medical term for a type of brain surgery which may be performed to treat severe, incapacitating mood disorders.

Key facts about NMD

  • NMD is only performed extremely rarely. For example, during 2012–13 only 4 people in the UK received NMD; in 2013–14 only 5 people were referred, although some of these people may have received an alternative treatment instead of NMD.
  • NMD is only offered if all other treatments have failed, including psychiatric medication and electroconvulsive therapy (ECT).
  • NMD is not a cure. Anyone who has NMD is likely to need continued psychiatric support afterwards, even if the surgery is considered to be successful.
  • The surgery cannot be reversed.
  • NMD is not available if you're under 20 years old.
  • NMD cannot be performed without your consent (in England and Wales).
  • There are two reversible alternatives to NMD available: deep brain stimulation (DBS) and vagus nerve stimulation (VNS).

Is NMD the same as lobotomy?

No. NMD is not lobotomy – the techniques used today are very different. In the past, brain surgery for mental health problems was called 'psychosurgery' and involved controversial techniques such as lobotomy, but this practice has not been used in the UK for many years.

What problems can NMD treat?

NMD can be used to treat:

However, if you've already tried both medication and electroconvulsive therapy (ECT), and nothing has worked, it's possible that NMD won't work for you either.

NMD is not used specifically to alter behaviour (although some change in behaviour may be one outcome), and is not offered for: personality disorders; schizophrenia; or anorexia (an eating problem) – although NMD is sometimes offered for anorexia outside the UK.

How does NMD work?

In NMD, an operation is carried out on the frontal lobes of your brain, which are behind your forehead. This area includes the limbic system, which is associated with your emotional responses (such as joy, fear and rage), and some physical responses you are not usually aware of (such as changes in your heart rate and blood pressure).

The aim of the operation is to disrupt connections between nerves in tiny areas of the limbic system which might be creating or contributing to your mental health problem.

(See our page about the operation for more details about how NMD is performed.)

How successful is NMD?

It's very difficult to measure how successful NMD is because so few people receive it, and it's only ever used for people with very severe illnesses for whom all other treatments have failed.

According to one study, which looked at a total of 25 cases of people who were treated with bilateral anterior cingulotomy (a type of NMD technique) collected over a period of years, 15 people (60%) showed improvement in symptoms of depression, and 5 people (20%) were no longer depressed after the operation. But there is no indication of how long this improvement lasted.

This information was published in May 2015. We will revise it in 2018.

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