title: Neurosurgical Treatments for Patients with Chronic, Treatment-Refractory Depression: A Retrospective, Consecutive, Case Series Comparison of Anterior Capsulotomy, Anterior Cingulotomy and Vagus Nerve Stimulation.
abstract: BACKGROUND
  The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory depression (TRD) remains weak. There is limited comparative information available to guide the choice of intervention for patients with the most severe and disabling forms of illness.
  
  
  OBJECTIVE
  The aim of this work was to describe the 12-month clinical outcomes of patients with chronic TRD treated with anterior capsulotomy (ACAPS; n = 5), anterior cingulotomy (ACING; n = 5) or vagus nerve stimulation (VNS; n = 5).
  
  
  METHODS
  We performed a retrospective, consecutive, case series comparison.
  
  
  RESULTS
  With clinical response defined as a ≥50% reduction from the baseline MADRS score, response rates were 40% for ACAPS, 60% for ACING and 20% for VNS. Adverse effects from all three procedures were relatively mild, consistent with previous reports and, in most cases, transient. Adverse effects from VNS were related to active stimulation, and were modifiable and diminished in severity over time. There were no deaths.
  
  
  CONCLUSIONS
  Although based on a small sample, our data represent a unique comparison of ACAPS, ACING and VNS for chronic TRD. The three cohorts were broadly equivalent in terms of baseline clinical characteristics, indices of chronicity, illness severity and estimates of previous failed treatments. ACING and ACAPS, but not VNS, were associated with favourable response rates at 12 months.
authors.affiliation: Advanced Interventions Service, NHS Tayside, and Division of Neuroscience, University of Dundee, Dundee, UK.
authors.forename: David
authors.initials: D
authors.lastname: Christmas
authors.forename: Keith
authors.initials: K
authors.lastname: Matthews
mesh_terms: D061218:Depressive Disorder, Treatment-Resistant / Q000601:surgery / Q000628:therapy*; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D011612:Psychosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation