title: Neuropsychological function before and after subcallosal cingulate deep brain stimulation in patients with treatment-resistant depression.
abstract: BACKGROUND
  Treatment-resistant depression (TRD) is a pervasive and difficult to treat condition for which deep brain stimulation (DBS) of the subcallosal cingulate white matter (SCCwm) is an emerging therapeutic option. However, neuropsychological safety data for this novel treatment have only been published for a small number of subjects. Moreover, little is known regarding the neuropsychological profile present in TRD patients at baseline, prior to initiation of DBS therapy. This report describes the neuropsychological effects of TRD and acute and chronic DBS of the SCCwm in patients with unipolar and bipolar TRD.
  
  
  METHODS
  Patients with TRD (N = 17) were compared to a healthy control group (N = 15) on subtests from the Cambridge Neuropsychological Test Automated Battery and the Stroop Task. Patients were then tested again at subsequent time points of 1 and 6 months following the initiation of chronic DBS of the SCCwm.
  
  
  RESULTS
  Patients with TRD showed similar levels of performance to healthy controls on most neuropsychological measures, with the exception that the TRD group had slower processing speed. Patients with bipolar TRD, relative to those with unipolar TRD, obtained lower scores on measures of executive function and memory only at baseline. With acute and chronic SCCwm DBS, neuropsychological function improved in multiple domains including processing speed and executive function (planning, set shifting, response inhibition), and memory remained stable.
  
  
  CONCLUSIONS
  Patients with TRD show slowed processing speed but otherwise largely preserved neuropsychological functioning. DBS of the SCCwm does not result in worsening of any aspect of neuropsychological function and may improve certain domains. Future research is warranted to better understand the effects of TRD and DBS on neuropsychological function.
authors.affiliation: Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jared L
authors.initials: JL
authors.lastname: Moreines
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kelley
authors.forename: Paul E
authors.initials: PE
authors.lastname: Holtzheimer
authors.forename: Helen S
authors.initials: HS
authors.lastname: Mayberg
mesh_terms: D000328:Adult; D003337:Corpus Callosum / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000379:methods*; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology* / Q000628:therapy*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016896:Treatment Outcome
keywords: deep brain stimulation; neuropsychology; subcallosal cingulate; treatment-resistant depression
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Ann Neurol. 2010 Oct;68(4):521-34
references.pmid: 20687206
references.citation: N Engl J Med. 2006 Mar 23;354(12):1243-52
references.pmid: 16554526
references.citation: Neuropsychology. 2010 Jan;24(1):9-34
references.pmid: 20063944
references.citation: Am J Psychiatry. 2006 Jan;163(1):28-40
references.pmid: 16390886
references.citation: Neuropsychol Rev. 1995 Sep;5(3):203-21
references.pmid: 8653109
references.citation: Psychother Psychosom. 1995;63(3-4):207-11
references.pmid: 7624468
references.citation: Bipolar Disord. 2009 Jun;11 Suppl 2:123-37
references.pmid: 19538691
references.citation: Arch Gen Psychiatry. 2012 Feb;69(2):150-8
references.pmid: 22213770
references.citation: Biol Psychiatry. 2009 Feb 15;65(4):267-75
references.pmid: 18842257
references.citation: Neuropsychology. 2012 Sep;26(5):642-651
references.pmid: 22823136
references.citation: Am J Psychiatry. 2000 Jul;157(7):1095-100
references.pmid: 10873917
references.citation: J Psychiatr Res. 2009 Jun;43(9):855-63
references.pmid: 19128810
references.citation: Arch Gen Psychiatry. 2004 Jun;61(6):587-95
references.pmid: 15184238
references.citation: Clin Neuropsychol. 1999 Aug;13(3):283-92
references.pmid: 10726600
references.citation: Depress Anxiety. 2012 Feb;29(2):139-46
references.pmid: 22095837
references.citation: Cereb Cortex. 2008 Jun;18(6):1374-83
references.pmid: 17928332
references.citation: Lancet Neurol. 2012 Feb;11(2):140-9
references.pmid: 22239915
references.citation: J Psychiatr Res. 2004 Nov-Dec;38(6):567-76
references.pmid: 15458852
references.citation: Biol Psychiatry. 2009 Feb 15;65(4):276-82
references.pmid: 19013554
references.citation: J Int Neuropsychol Soc. 2012 May;18(3):606-11
references.pmid: 22264411
references.citation: Dialogues Clin Neurosci. 2008;10(2):153-63
references.pmid: 18689286
references.citation: J Nerv Ment Dis. 2008 May;196(5):405-10
references.pmid: 18477883
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):617-27
references.pmid: 15939839
references.citation: Neuropsychologia. 1994 Feb;32(2):249-55
references.pmid: 8190248
references.citation: Neuropsychologia. 2001;39(3):219-30
references.pmid: 11163601
references.citation: Biol Psychiatry. 2001 Jul 1;50(1):35-43
references.pmid: 11457422
references.citation: Brain. 2009 May;132(Pt 5):1310-23
references.pmid: 19042931
references.citation: N Engl J Med. 2006 Mar 23;354(12):1231-42
references.pmid: 16554525
references.citation: J Affect Disord. 1994 Dec;32(4):257-69
references.pmid: 7897090
references.citation: Biol Psychiatry. 2010 Jan 15;67(2):e9-e11
references.pmid: 19846068
references.citation: J Int Neuropsychol Soc. 1998 Sep;4(5):474-90
references.pmid: 9745237
references.citation: Neuron. 2005 Mar 3;45(5):651-60
references.pmid: 15748841
references.citation: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references.pmid: 14399272
references.citation: Biol Psychiatry. 2010 Jan 15;67(2):110-6
references.pmid: 19914605
references.citation: Bipolar Disord. 2011 Jun;13(4):365-76
references.pmid: 21843276
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):593-602
references.pmid: 15939837
references.citation: Biol Psychiatry. 2005 Mar 1;57(5):510-6
references.pmid: 15737666
references.citation: J Clin Psychiatry. 2009 Nov;70(11):1588-97
references.pmid: 19689922
references.citation: J Clin Psychiatry. 2007;68 Suppl 8:17-25
references.pmid: 17640154
references.citation: Dement Geriatr Cogn Disord. 2004;17(1-2):42-8
references.pmid: 14560064
references.citation: Annu Rev Neurosci. 2009;32:57-74
references.pmid: 19400725
references.citation: Brain Stimul. 2011 Jan;4(1):17-27
references.pmid: 21255751
references.citation: Arch Clin Neuropsychol. 2006 Oct;21(7):669-76
references.pmid: 16908116
references.citation: Psychiatry Res. 2008 Jul 15;160(1):72-82
references.pmid: 18501971
references.citation: J Int Neuropsychol Soc. 2003 Mar;9(3):419-28
references.pmid: 12666766
references.citation: Arch Gen Psychiatry. 2002 Jul;59(7):597-604
references.pmid: 12090812
references.citation: Arch Neurol. 2012 Sep;69(9):1141-8
references.pmid: 22566505
references.citation: Biol Psychiatry. 2008 Sep 15;64(6):461-7
references.pmid: 18639234
references.citation: J Clin Exp Neuropsychol. 1992 Mar;14(2):268-88
references.pmid: 1572949
references.citation: Eur J Neurosci. 1996 Feb;8(2):353-64
references.pmid: 8714706
references.citation: Encephale. 2002 Mar-Apr;28(2):97-107
references.pmid: 11972136