Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression.
BACKGROUND
We investigated the use of deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) for treatment refractory depression.


METHODS
Fifteen patients with chronic, severe, highly refractory depression received open-label DBS at three collaborating clinical sites. Electrodes were implanted bilaterally in the VC/VS region. Stimulation was titrated to therapeutic benefit and the absence of adverse effects. All patients received continuous stimulation and were followed for a minimum of 6 months to longer than 4 years. Outcome measures included the Hamilton Depression Rating Scale-24 item (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Global Assessment of Function Scale (GAF).


RESULTS
Significant improvements in depressive symptoms were observed during DBS treatment. Mean HDRS scores declined from 33.1 at baseline to 17.5 at 6 months and 14.3 at last follow-up. Similar improvements were seen with the MADRS (34.8, 17.9, and 15.7, respectively) and the GAF (43.4, 55.5, and 61.8, respectively). Responder rates with the HDRS were 40% at 6 months and 53.3% at last follow-up (MADRS: 46.7% and 53.3%, respectively). Remission rates were 20% at 6 months and 40% at last follow-up with the HDRS (MADRS: 26.6% and 33.3%, respectively). The DBS was well-tolerated in this group.


CONCLUSIONS
Deep brain stimulation of the VC/VS offers promise for the treatment of refractory major depression.
Department of Psychiatry and Psychology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA. maloned@ccf.org
Donald A
DA
Malone
Darin D
DD
Dougherty
Ali R
AR
Rezai
Linda L
LL
Carpenter
Gerhard M
GM
Friehs
Emad N
EN
Eskandar
Scott L
SL
Rauch
Steven A
SA
Rasmussen
Andre G
AG
Machado
Cynthia S
CS
Kubu
Audrey R
AR
Tyrka
Lawrence H
LH
Price
Paul H
PH
Stypulkowski
Jonathon E
JE
Giftakis
Mark T
MT
Rise
Paul F
PF
Malloy
Stephen P
SP
Salloway
Benjamin D
BD
Greenberg
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003071:Cognition / Q000502:physiology; D046690:Deep Brain Stimulation / Q000009:adverse effects; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004351:Drug Resistance; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017072:Neostriatum / Q000502:physiology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult