Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression

Donald A Malone Jr, Darin D Dougherty, Ali R Rezai, Linda L Carpenter, Gerhard M Friehs, Emad N Eskandar, Scott L Rauch, Steven A Rasmussen, Andre G Machado, Cynthia S Kubu, Audrey R Tyrka, Lawrence H Price, Paul H Stypulkowski, Jonathon E Giftakis, Mark T Rise, Paul F Malloy, Stephen P Salloway, Benjamin D Greenberg, Donald A Malone Jr, Darin D Dougherty, Ali R Rezai, Linda L Carpenter, Gerhard M Friehs, Emad N Eskandar, Scott L Rauch, Steven A Rasmussen, Andre G Machado, Cynthia S Kubu, Audrey R Tyrka, Lawrence H Price, Paul H Stypulkowski, Jonathon E Giftakis, Mark T Rise, Paul F Malloy, Stephen P Salloway, Benjamin D Greenberg

Abstract

Background: We investigated the use of deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) for treatment refractory depression.

Methods: Fifteen patients with chronic, severe, highly refractory depression received open-label DBS at three collaborating clinical sites. Electrodes were implanted bilaterally in the VC/VS region. Stimulation was titrated to therapeutic benefit and the absence of adverse effects. All patients received continuous stimulation and were followed for a minimum of 6 months to longer than 4 years. Outcome measures included the Hamilton Depression Rating Scale-24 item (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Global Assessment of Function Scale (GAF).

Results: Significant improvements in depressive symptoms were observed during DBS treatment. Mean HDRS scores declined from 33.1 at baseline to 17.5 at 6 months and 14.3 at last follow-up. Similar improvements were seen with the MADRS (34.8, 17.9, and 15.7, respectively) and the GAF (43.4, 55.5, and 61.8, respectively). Responder rates with the HDRS were 40% at 6 months and 53.3% at last follow-up (MADRS: 46.7% and 53.3%, respectively). Remission rates were 20% at 6 months and 40% at last follow-up with the HDRS (MADRS: 26.6% and 33.3%, respectively). The DBS was well-tolerated in this group.

Conclusions: Deep brain stimulation of the VC/VS offers promise for the treatment of refractory major depression.

Conflict of interest statement

Dr. Malloy reports no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1
Figure 1
Magnetic resonance images from a representative patient showing preoperative targeting (left) and postoperative deep brain stimulation (DBS) lead position (right). Image distortion due to artifact from the metal components of the DBS lead causes the size of the lead to appear larger than actual.
Figure 2
Figure 2
Change in Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HDRS) over time for the subject population.
Figure 3
Figure 3
Change in Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HDRS) over 6 months in responders versus nonresponders.

Source: PubMed

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