Characterizing the therapeutic response to deep brain stimulation for treatment-resistant depression: a single center long-term perspective

Andrea L Crowell, Steven J Garlow, Patricio Riva-Posse, Helen S Mayberg, Andrea L Crowell, Steven J Garlow, Patricio Riva-Posse, Helen S Mayberg

Abstract

The number of depressed patients treated with deep brain stimulation (DBS) is relatively small. However, experience with this intervention now spans more than 10 years at some centers, with study subjects typically monitored closely. Here we describe one center's evolving impressions regarding optimal patient selection for DBS of the subcallosal cingulate (SCC) as well as observations of short- and long-term patterns in antidepressant response and mood reactivity. A consistent time course of therapeutic response with distinct behavioral phases is observed. Early phases are characterized by changes in mood reactivity and a transient and predictable worsening in self ratings prior to stabilization of response. It is hypothesized that this characteristic recovery curve reflects the timeline of neuroplasticity in response to DBS. Further investigation of these emerging predictable psychiatric, biological, and psychosocial patterns will both improve treatment optimization and enhance understanding and recognition of meaningful DBS antidepressant effects.

Keywords: deep brain stimulation; emotional reactivity; subcallosal cingulate; therapeutic course; treatment resistant depression.

References

    1. Afshar P., Khambhati A., Stanslaski S., Carlson D., Jensen R., Linde D., et al. . (2013). A translational platform for prototyping closed-loop neuromodulation systems. Front. Neural Circuits 6:117. 10.3389/fncir.2012.00117
    1. Bagby R. M., Ryder A. G., Schuller D. R., Marshall M. B. (2004). The Hamilton depression rating scale: has the gold standard become a lead weight? Am. J. Psychiatry 161, 2163–2177. 10.1176/appi.ajp.161.12.2163
    1. Bech P., Gram L. F., Dein E., Jacobsen O., Vitger J., Bolwig T. G. (1975). Quantitative rating of depressive states. Acta Psychiatr. Scand. 51, 161–170. 10.1111/j.1600-0447.1975.tb00002.x
    1. Bewernick B. H., Hurlemann R., Matusch A., Kayser S., Grubert C., Hadrysiewicz B., et al. . (2010). Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol. Psychiatry 67, 110–116. 10.1016/j.biopsych.2009.09.013
    1. Bewernick B. H., Kayser S., Sturm V., Schlaepfer T. E. (2012). Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuropsychopharmacology 37, 1975–1985. 10.1038/npp.2012.44
    1. Broadway J. M., Holtzheimer P. E., Hilimire M. R., Parks N. A., Devylder J. E., Mayberg H. S., et al. . (2012). Frontal theta cordance predicts 6-month antidepressant response to subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study. Neuropsychopharmacology 37, 1764–1772. 10.1038/npp.2012.23
    1. Brunoni A. R., Lopes M., Fregni F. (2008). A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int. J. Neuropsychopharmacol. 11, 1169–1180. 10.1017/S1461145708009309
    1. Dougherty D. D., Rezai A. R., Carpenter L. L., Howland R. H., Bhati M. T., O’Reardon J. P., et al. . (2014). A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biol. Psychiatry [Epub ahead of print]. 10.1016/j.biopsych.2014.11.023
    1. Gibson E. M., Purger D., Mount C. W., Goldstein A. K., Lin G. L., Wood L. S., et al. . (2014). Neuronal activity promotes oligodendrogenesis and adaptive myelination in the mammalian brain. Science 344:1252304. 10.1126/science.1252304
    1. Hamani C., Machado D. C., Hipolide D. C., Dubiela F. P., Suchecki D., Macedo C. E., et al. . (2012). Deep brain stimulation reverses anhedonic-like behavior in a chronic model of depression: role of serotonin and brain derived neurotrophic factor. Biol. Psychiatry 71, 30–35. 10.1016/j.biopsych.2011.08.025
    1. Holtzheimer P. E., Kelley M. E., Gross R. E., Filkowski M. M., Garlow S. J., Barrocas A., et al. . (2012). Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch. Gen. Psychiatry 69, 150–158. 10.1001/archgenpsychiatry.2011.1456
    1. Hosain M. K., Kouzani A., Tye S. (2014). Closed loop deep brain stimulation: an evolving technology. Australas Phys. Eng. Sci. Med. 37, 619–634. 10.1007/s13246-014-0297-2
    1. Hristova A., Lyons K., Troster A. I., Pahwa R., Wilkinson S. B., Koller W. C. (2000). Effect and time course of deep brain stimulation of the globus pallidus and subthalamus on motor features of Parkinson’s disease. Clin. Neuropharmacol. 23, 208–211. 10.1097/00002826-200007000-00007
    1. Kennedy S. H., Giacobbe P., Rizvi S. J., Placenza F. M., Nishikawa Y., Mayberg H. S., et al. . (2011). Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am. J. Psychiatry 168, 502–510. 10.1176/appi.ajp.2010.10081187
    1. Lozano A. M., Giacobbe P., Hamani C., Rizvi S. J., Kennedy S. H., Kolivakis T. T., et al. . (2012). A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. J. Neurosurg. 116, 315–322. 10.3171/2011.10.JNS102122
    1. Lozano A. M., Mayberg H. S., Giacobbe P., Hamani C., Craddock R. C., Kennedy S. H. (2008). Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol. Psychiatry 64, 461–467. 10.1016/j.biopsych.2008.05.034
    1. Malone D. A., Jr., Dougherty D. D., Rezai A. R., Carpenter L. L., Friehs G. M., Eskandar E. N., et al. . (2009). Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol. Psychiatry 65, 267–275. 10.1016/j.biopsych.2008.08.029
    1. Mayberg H. S., Lozano A. M., Voon V., McNeely H. E., Seminowicz D., Hamani C., et al. . (2005). Deep brain stimulation for treatment-resistant depression. Neuron 45, 651–660. 10.1016/j.neuron.2005.02.014
    1. Merkl A., Schneider G. H., Schonecker T., Aust S., Kühl K. P., Kupsch A., et al. . (2013). Antidepressant effects after short-term and chronic stimulation of the subgenual cingulate gyrus in treatment-resistant depression. Exp. Neurol. 249, 160–168. 10.1016/j.expneurol.2013.08.017
    1. Okun M. S., Bowers D., Springer U., Shapira N. A., Malone D., Rezai A. R., et al. . (2004). What’s in a “smile?” intra-operative observations of contralateral smiles induced by deep brain stimulation. Neurocase 10, 271–279. 10.1080/13554790490507632
    1. Puigdemont D., Pérez-Egea R., Portella M. J., Molet J., de Diego-Adelino J., Gironell A., et al. . (2012). Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression. Int. J. Neuropsychopharmacol. 15, 121–133. 10.1017/s1461145711001088
    1. Ramasubbu R., Anderson S., Haffenden A., Chavda S., Kiss Z. H. (2013). Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study. J. Psychiatry Neurosci. 38, 325–332. 10.1503/jpn.120160
    1. Riva-Posse P., Choi K. S., Holtzheimer P. E., McIntyre C. C., Gross R. E., Chaturvedi A., et al. . (2014b). Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression. Biol. Psychiatry 76, 963–969. 10.1016/j.biopsych.2014.03.029
    1. Riva-Posse P., Inman C., Choi K., Hamann S., Garlow S., Gross R., et al. (2014a). Tractography and autonomic correlates of acute intraoperative subcallosal cingulate deep brain stimulation. Biol. Psychiatry 75, 16S–16S. 10.1016/j.biopsych.2014.03.014
    1. Ruge D., Cif L., Limousin P., Gonzalez V., Vasques X., Hariz M. I., et al. . (2011). Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms. Brain 134, 2106–2115. 10.1093/brain/awr122
    1. Schlaepfer T. E., Bewernick B. H., Kayser S., Mädler B., Coenen V. A. (2013). Rapid effects of deep brain stimulation for treatment-resistant major depression. Biol. Psychiatry 73, 1204–1212. 10.1016/j.biopsych.2013.01.034
    1. Schlaepfer T. E., Cohen M. X., Frick C., Kosel M., Brodesser D., Axmacher N., et al. . (2008). Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33, 368–377. 10.1038/sj.npp.1301408
    1. Smart O. L., Tiruvadi V. R., Mayberg H. S. (2015). Multimodal approaches to define network oscillations in depression. Biol. Psychiatry 77, 1061–1070. 10.1016/j.biopsych.2015.01.002
    1. Snaith R. P. (1977). Hamilton rating scale for depression. Br. J. Psychiatry 131, 431–432. 10.1192/bjp.131.4.431
    1. Yianni J., Bain P. G., Gregory R. P., Nandi D., Joint C., Scott R. B., et al. . (2003). Post-operative progress of dystonia patients following globus pallidus internus deep brain stimulation. Eur. J. Neurol. 10, 239–247. 10.1046/j.1468-1331.2003.00592.x

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する