Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression.
BACKGROUND
While most patients with depression respond to combinations of pharmacotherapy, psychotherapy, and electroconvulsive therapy (ECT), there are patients requiring other treatments. Deep brain stimulation (DBS) allows modulation of brain regions that are dysfunctional in depression. Since anhedonia is a feature of depression and there is evidence of dysfunction of the reward system, DBS to the nucleus accumbens (NAcc) might be promising.


METHODS
Ten patients suffering from very resistant forms of depression (treatment-resistant depression [TRD]), not responding to pharmacotherapy, psychotherapy, or ECT, were implanted with bilateral DBS electrodes in the NAcc. The mean (+/-SD) length of the current episode was 10.8 (+/-7.5) years; the number of past treatment courses was 20.8 (+/-8.4); and the mean Hamilton Depression Rating Scale (HDRS) was 32.5 (+/-5.3).


RESULTS
Twelve months following initiation of DBS treatment, five patients reached 50% reduction of the HDRS (responders, HDRS = 15.4 [+/-2.8]). The number of hedonic activities increased significantly. Interestingly, ratings of anxiety (Hamilton Anxiety Scale) were reduced in the whole group but more pronounced in the responders. The [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography data revealed that NAcc-DBS decreased metabolism in the subgenual cingulate and in prefrontal regions including orbital prefrontal cortex. A volume of interest analysis comparing responders and nonresponders identified metabolic decreases in the amygdala.


CONCLUSIONS
We demonstrate antidepressant and antianhedonic effects of DBS to NAcc in patients suffering from TRD. In contrast to other DBS depression studies, there was also an antianxiety effect. These effects are correlated with localized metabolic changes.
Bewernick
Bettina H
BH
Department of Psychiatry and Psychotherapy, University Hospital, 53105 Bonn, Germany.
Hurlemann
René
R
Matusch
Andreas
A
Kayser
Sarah
S
Grubert
Christiane
C
Hadrysiewicz
Barbara
B
Axmacher
Nikolai
N
Lemke
Matthias
M
Cooper-Mahkorn
Deirdre
D
Cohen
Michael X
MX
Brockmann
Holger
H
Lenartz
Doris
D
Sturm
Volker
V
Schlaepfer
Thomas E
TE
D000328:Adult; D000368:Aged; D000679:Amygdala / Q000000981:diagnostic imaging; D001931:Brain Mapping; D046690:Deep Brain Stimulation / Q000379:methods*; D003863:Depression / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009714:Nucleus Accumbens / Q000000981:diagnostic imaging / Q000502:physiology*; D049268:Positron-Emission Tomography / Q000379:methods; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18