title: Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease?
abstract: BACKGROUND
  Deep brain stimulation (DBS) has been associated with mood sequelae in a subset of patients operated on in either the subthalamic nucleus or the globus pallidus internus for the treatment of Parkinson disease.
  
  
  OBJECTIVE
  To compare mood and motor outcomes in those with and without a presurgical history of depression.
  
  
  METHODS
  Unilateral subthalamic nucleus or unilateral globus pallidus internus DBS patients followed up for a minimum of 6 months were included. All patients underwent a comprehensive outpatient psychiatric evaluation by a board-certified psychiatrist. Psychiatric diagnoses were based on Diagnostic and Statistical Manual, fourth edition, text revision, nomenclature (American Psychiatric Association, 2000). Motor and mood outcomes were compared.
  
  
  RESULTS
  A total of 110 patients were included. There were no significant differences in baseline variables between the 2 groups. Those with a preoperative history of depression had significantly higher Beck Depression Inventory scores than the nondepression group after DBS (8.97 ± 7.55 vs 5.92 ± 5.71; P = .04). Patients with a depression history had less improvement (11.6%) in pre/post-DBS change when Unified Parkinson Disease Rating Scale motor scores were compared (P = .03) after adjustment for stimulation site and baseline demographic and clinical variables. Patients with a higher levodopa equivalent dose had a worse clinical motor outcome.
  
  
  CONCLUSIONS
  Patients with a preoperative depression history had higher Beck Depression Inventory scores after DBS and significantly less (albeit small) improvement in pre/post-DBS change in Unified Parkinson Disease Rating Scale motor scores than patients without a history of depression.
authors.affiliation: UF Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32607, USA. okun@neurology.ufl.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.forename: Shilpa
authors.initials: S
authors.lastname: Gogna
authors.forename: Catherine
authors.initials: C
authors.lastname: Price
authors.forename: Irene
authors.initials: I
authors.lastname: Malaty
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Rodriguez
authors.forename: Charles E
authors.initials: CE
authors.lastname: Jacobson
authors.forename: Herbert
authors.initials: H
authors.lastname: Ward
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects*; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies