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.

What is NMD?

Neurosurgery for mental disorder (NMD) is the medical term for a type of brain surgery used in very rare cases to treat severe and long-lasting mental health problems, when all other treatments have failed.

The aim of the surgery is to destroy small areas of brain tissue that may be contributing to your mental health problems. (See our page about the operation for more details about how NMD is performed.)

There are very serious risks associated with NMD. Your doctor should only discuss this option with you if you have already tried all other treatment options and found that they haven’t helped.

Examples of other treatments you may try before considering NMD are:

What problems can NMD treat?

NMD is not currently recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of mental health problems. This is because there is a lack of evidence of its safety and how effective it is.

However, in very rare cases, NMD is used to treat:

How effective is NMD?

It's very difficult to know how effective NMD is at treating mental health problems. This is because so few people receive it and different surgical techniques are used.

There are a number of research studies suggesting that it may help to reduce the symptoms of severe depression and OCD, which haven’t been helped by other treatments. However, there is limited research exploring how long these benefits last.

If you think NMD could be the right treatment for you, it is important to speak to your GP and psychiatrist about the benefits and risks of having the treatment.

They may suggest you try other treatments first or they may refer you for an assessment to see whether NMD may be able to help reduce the symptoms you experience.

(See our information on who could be offered NMD for more information.)

Key facts about NMD

  • It cannot be performed without your consent (in England and Wales).
  • It is only performed extremely rarely. During 2015 to 2016 only 4 NMD procedures were conducted at the Ninewells hospital in Dundee, which is one of the two treatment centres in the UK.
  • It is only offered if all other treatments have failed.
  • It 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.

There are two reversible alternatives to NMD available:

This information was published in February 2018. We will revise it in 2021.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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