title: Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression.
abstract: BACKGROUND
  The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).
  
  
  METHODS
  This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery-Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.
  
  
  RESULTS
  Patients improved on the clinical measure of depression after surgery by -21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.
  
  
  CONCLUSIONS
  With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University,Cardiff,UK.
authors.forename: L
authors.initials: L
authors.lastname: Subramanian
authors.affiliation: Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University,Cardiff,UK.
authors.forename: T
authors.initials: T
authors.lastname: Bracht
authors.affiliation: Cyncoed Consulting Rooms,Cardiff,UK.
authors.forename: P
authors.initials: P
authors.lastname: Jenkins
authors.affiliation: Universite Pierre et Marie Curie,Paris,France.
authors.forename: S
authors.initials: S
authors.lastname: Choppin
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University,Cardiff,UK.
authors.forename: D E J
authors.initials: DE
authors.lastname: Linden
authors.affiliation: Cardiff and Vale University Health Board,Cardiff,UK.
authors.forename: G
authors.initials: G
authors.lastname: Phillips
authors.affiliation: Cardiff and Vale University Health Board,Cardiff,UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Simpson
mesh_terms: D000328:Adult; D061218:Depressive Disorder, Treatment-Resistant / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies
keywords: Anterior capsulotomy; depression; mood disorder; stereotactic neurosurgery; treatment resistance