title: Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression.
abstract: Deep brain stimulation (DBS) is currently tested as an experimental therapy for patients with treatment-resistant depression (TRD). Here we report on the short- and long-term (1 yr) clinical outcomes and tolerance of DBS in eight TRD patients. Electrodes were implanted bilaterally in the subgenual cingulate gyrus (SCG; Broadman areas 24-25), and stimulated at 135 Hz (90-μs pulsewidth). Voltage and active electrode contacts were adjusted to maximize short-term responses. Clinical assessments included the 17-item Hamilton Depression Rating Scale (HAMD17; primary measure), the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) Scale. In the first week after surgery, response and remission (HAMD ⩽7) rates were, respectively 87.5% and 50%. These early responses were followed by an overall worsening, with a response and remission rates of 37.5% (3/8) at 1 month. From then onwards, patients showed a progressive improvement, with response and remission rates of 87.5% and 37.5%, respectively, at 6 months. The corresponding figures at 1 yr were 62.5% and 50%, respectively. Clinical effects were seen in all HAMD subscales without a significant incidence of side-effects. Surgical procedure and post-operative period were well-tolerated for all patients. This is the second independent study on the use of DBS of the SCG to treat chronic depression resistant to current therapeutic strategies. DBS fully remitted 50% of the patients at 1 yr, supporting its validity as a new therapeutic strategy for TRD.
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Puigdemont
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Pérez-Egea
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Portella
authors.affiliation: Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Molet
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Diego-Adeliño
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Gironell
authors.affiliation: Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital de les Germanes Hospitalàries Benito Menni, Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Radua
authors.affiliation: Department of Neuroimaging, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Gómez-Anson
authors.affiliation: Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rodríguez
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Serra
authors.affiliation: Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Cristian
authors.initials: C
authors.lastname: de Quintana
authors.affiliation: Department of Neurochemistry and Neuropharmacology, Institut d'Investigacions Biomèdiques de Barcelona, IDIBAPS, Consejo Superior de Investigaciones Cientificas (CSIC), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Artigas
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Álvarez
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Pérez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology* / Q000628:therapy*; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult