Deep brain stimulation for treatment-resistant depression.
Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.
Mayberg
Helen S
HS
Rotman Research Institute at Baycrest Centre, and Departments of Psychiatry and Neurology, University of Toronto, Toronto, Ontario, M6A 2E1, Canada. hmayber@emory.edu
Lozano
Andres M
AM
Voon
Valerie
V
McNeely
Heather E
HE
Seminowicz
David
D
Hamani
Clement
C
Schwalb
Jason M
JM
Kennedy
Sidney H
SH
D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D003865:Major Depressive Disorder / Q000378:metabolism / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006179:Gyrus Cinguli / Q000378:metabolism / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods; D011569:Psychiatric Status Rating Scales