Prospective Assessment of Stereotactic Ablative Surgery for Intractable Major Depression

Donald C. Shields, Wael Asaad, Emad N. Eskandar, Felipe A. Jain, G. Rees Cosgrove, Alice W. Flaherty, Edwin H. Cassem, Bruce H. Price, Scott L. Rauch, Darin D. Dougherty

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Despite therapeutic advances for major depression, a subset of patients with this disorder does not respond to conventional treatment. Stereotactic ablative procedures such as anterior cingulotomy have been performed in severely affected, treatment-resistant patients, but the long-term results of such procedures are not fully understood. Methods: Findings are reported for 33 patients with severe treatment-resistant major depression who underwent ablative stereotactic procedures (dorsal anterior cingulotomy followed if necessary by subcaudate tractotomy). Preoperative and long-term postoperative Beck Depression Inventory scores were obtained along with postoperative Clinical Global Improvement values. Both were analyzed to evaluate patients' responses to the surgical procedure(s). Results: At mean follow-up of 30 months after one or more stereotactic ablative procedures, 11 patients (33.3%) were classified as responders, 14 (42.4%) were partial responders, and 8 (24.2%) did not respond to the surgical procedure(s). Among those (17) who underwent only one procedure, seven (41.2%) responded, whereas six (35.3%) and four (23.5%) showed partial or no response, respectively. Among patients who required multiple surgical procedures, four patients (25%) responded, whereas eight (50%) and four (25%) patients demonstrated partial or no responses, respectively, at long-term follow-up evaluations. Conclusions: Approximately 75% of depression patients previously resistant to antidepressant therapies received partial or substantial benefit from stereotactic ablative procedures. Those requiring only a single anterior cingulotomy tended to demonstrate more pronounced responses than patients who underwent multiple surgical procedures.

Original languageEnglish (US)
Pages (from-to)449-454
Number of pages6
JournalBiological Psychiatry
Volume64
Issue number6
DOIs
StatePublished - Sep 15 2008
Externally publishedYes

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Depression
Treatment-Resistant Depressive Disorder
Therapeutics
Antidepressive Agents
Equipment and Supplies

Keywords

  • Anterior cingulotomy
  • limbic leucotomy
  • major depression
  • microelectrode recording
  • stereotactic ablation
  • subcaudate tractotomy

ASJC Scopus subject areas

  • Biological Psychiatry

Cite this

Shields, D. C., Asaad, W., Eskandar, E. N., Jain, F. A., Cosgrove, G. R., Flaherty, A. W., ... Dougherty, D. D. (2008). Prospective Assessment of Stereotactic Ablative Surgery for Intractable Major Depression. Biological Psychiatry, 64(6), 449-454. https://doi.org/10.1016/j.biopsych.2008.04.009

Prospective Assessment of Stereotactic Ablative Surgery for Intractable Major Depression. / Shields, Donald C.; Asaad, Wael; Eskandar, Emad N.; Jain, Felipe A.; Cosgrove, G. Rees; Flaherty, Alice W.; Cassem, Edwin H.; Price, Bruce H.; Rauch, Scott L.; Dougherty, Darin D.

In: Biological Psychiatry, Vol. 64, No. 6, 15.09.2008, p. 449-454.

Research output: Contribution to journalArticle

Shields, DC, Asaad, W, Eskandar, EN, Jain, FA, Cosgrove, GR, Flaherty, AW, Cassem, EH, Price, BH, Rauch, SL & Dougherty, DD 2008, 'Prospective Assessment of Stereotactic Ablative Surgery for Intractable Major Depression', Biological Psychiatry, vol. 64, no. 6, pp. 449-454. https://doi.org/10.1016/j.biopsych.2008.04.009
Shields, Donald C. ; Asaad, Wael ; Eskandar, Emad N. ; Jain, Felipe A. ; Cosgrove, G. Rees ; Flaherty, Alice W. ; Cassem, Edwin H. ; Price, Bruce H. ; Rauch, Scott L. ; Dougherty, Darin D. / Prospective Assessment of Stereotactic Ablative Surgery for Intractable Major Depression. In: Biological Psychiatry. 2008 ; Vol. 64, No. 6. pp. 449-454.
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abstract = "Background: Despite therapeutic advances for major depression, a subset of patients with this disorder does not respond to conventional treatment. Stereotactic ablative procedures such as anterior cingulotomy have been performed in severely affected, treatment-resistant patients, but the long-term results of such procedures are not fully understood. Methods: Findings are reported for 33 patients with severe treatment-resistant major depression who underwent ablative stereotactic procedures (dorsal anterior cingulotomy followed if necessary by subcaudate tractotomy). Preoperative and long-term postoperative Beck Depression Inventory scores were obtained along with postoperative Clinical Global Improvement values. Both were analyzed to evaluate patients' responses to the surgical procedure(s). Results: At mean follow-up of 30 months after one or more stereotactic ablative procedures, 11 patients (33.3{\%}) were classified as responders, 14 (42.4{\%}) were partial responders, and 8 (24.2{\%}) did not respond to the surgical procedure(s). Among those (17) who underwent only one procedure, seven (41.2{\%}) responded, whereas six (35.3{\%}) and four (23.5{\%}) showed partial or no response, respectively. Among patients who required multiple surgical procedures, four patients (25{\%}) responded, whereas eight (50{\%}) and four (25{\%}) patients demonstrated partial or no responses, respectively, at long-term follow-up evaluations. Conclusions: Approximately 75{\%} of depression patients previously resistant to antidepressant therapies received partial or substantial benefit from stereotactic ablative procedures. Those requiring only a single anterior cingulotomy tended to demonstrate more pronounced responses than patients who underwent multiple surgical procedures.",
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AU - Cosgrove, G. Rees

AU - Flaherty, Alice W.

AU - Cassem, Edwin H.

AU - Price, Bruce H.

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AU - Dougherty, Darin D.

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