TY - JOUR
T1 - Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression
AU - Malone, Donald A.
AU - Dougherty, Darin D.
AU - Rezai, Ali R.
AU - Carpenter, Linda L.
AU - Friehs, Gerhard M.
AU - Eskandar, Emad N.
AU - Rauch, Scott L.
AU - Rasmussen, Steven A.
AU - Machado, Andre G.
AU - Kubu, Cynthia S.
AU - Tyrka, Audrey R.
AU - Price, Lawrence H.
AU - Stypulkowski, Paul H.
AU - Giftakis, Jonathon E.
AU - Rise, Mark T.
AU - Malloy, Paul F.
AU - Salloway, Stephen P.
AU - Greenberg, Benjamin D.
N1 - Funding Information:
This study was funded by Medtronic.We wish to thank: Bart Nuttin, Volker Sturm, and Robert Coffey for consultation on neurosurgical issues; Loes Gabriels for consultation on psychiatric issues; Patty St. Marie, Natalie Sykuta, Jenna Stump, and Rouba Youssef for help with data management; Rees Cosgrove, Paul Summergrad, and Naomi Simon for data and safety monitoring-board roles; and Richard Marsland and Steven Zella for assistance in patient care.
PY - 2009/2/15
Y1 - 2009/2/15
N2 - 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.
AB - 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.
KW - Deep brain stimulation
KW - efficacy
KW - major depression
KW - ventral capsule/ventral striatum
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U2 - 10.1016/j.biopsych.2008.08.029
DO - 10.1016/j.biopsych.2008.08.029
M3 - Article
C2 - 18842257
AN - SCOPUS:58349091436
SN - 0006-3223
VL - 65
SP - 267
EP - 275
JO - Biological Psychiatry
JF - Biological Psychiatry
IS - 4
ER -