Priority CommunicationSubcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression
Section snippets
Patients
Twenty patients with TRD received DBS of the SCG between May 2003 and November 2006 (Table 1). Referrals came from hospital and community psychiatrists who were aware of the protocol and were not directly involved in its implementation. All patients met criteria for major depressive disorder (MDD), were in a current major depressive episode (MDE) as determined by the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P) (18), and had a minimum score of 20 on the
Primary Outcome Measures
The clinical and demographic features of 20 patients with TRD undergoing SCG DBS are shown in Table 1. We treated 9 men and 11 women with SCG DBS. All had failed multiple trials of pharmacotherapy and psychotherapy and all but three (who refused) also received a course of electroconvulsive therapy during the current episode without response. The mean duration of the current major depressive episode was 6.9 years (SD 5.6). One patient who initially was diagnosed with unipolar depression had more
Impact of DBS on TRD
We found that SCG DBS produced robust improvements in depression in patients with TRD. Benefits were seen across multiple domains of depression as reflected by improvements in each of the mood, anxiety, somatic, and sleep subcomponents of the HRSD-17 scale. The maximal benefits were delayed and progressive. They reached a plateau at 6 months and were generally sustained up to last time point measured at 12 months. Patients who showed a benefit at 1 month were likely to maintain response 6 and
Conclusion
We conclude that SCG DBS improves many of the symptoms of severe depression in patients who have failed to respond to conventional treatments. Improvements are seen within 1 month and last for at least 1 year. The procedure is well tolerated and no patient suffered a permanent serious adverse effect. In contrast to previously utilized ablative neurosurgical procedures for depression, DBS is adjustable and stimulation is reversible. These features increase safety and may offer advantages for
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