A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression

Clinical article

Restricted access

Object

Deep brain stimulation (DBS) has been recently investigated as a treatment for major depression. One of the proposed targets for this application is the subcallosal cingulate gyrus (SCG). To date, promising results after SCG DBS have been reported by a single center. In the present study the authors investigated whether these findings may be replicated at different institutions. They conducted a 3-center prospective open-label trial of SCG DBS for 12 months in patients with treatment-resistant depression.

Methods

Twenty-one patients underwent implantation of bilateral SCG electrodes. The authors examined the reduction in Hamilton Rating Scale for Depression (HRSD-17) score from baseline (RESP50).

Results

Patients treated with SCG DBS had an RESP50 of 57% at 1 month, 48% at 6 months, and 29% at 12 months. The response rate after 12 months of DBS, however, increased to 62% when defined as a reduction in the baseline HRSD-17 of 40% or more. Reductions in depressive symptomatology were associated with amelioration in disease severity in patients who responded to surgery.

Conclusions

Overall, findings from this study corroborate the results of previous reports showing that outcome of SCG DBS may be replicated across centers.

Abbreviations used in this paper: CGI-S = Clinical Global Impression–Severity; DBS = deep brain stimulation; HRSD-17 = 17-item Hamilton Rating Scale for Depression; RESP50 = a minimum 50% reduction in the HRSD-17 score from baseline; SCG = subcallosal cingulate gyrus; TRD = treatment-resistant depression.
Article Information

Contributor Notes

Address correspondence to: Andres M. Lozano, M.D., Ph.D., Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, WW 4-447, Toronto, Ontario M5T 2S8, Canada. email: lozano@uhnresearch.ca.Please include this information when citing this paper: published online November 18, 2011; DOI: 10.3171/2011.10.JNS102122.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Bewernick BHHurlemann RMatusch AKayser SGrubert CHadrysiewicz B: Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol Psychiatry 67:1101162010

    • Search Google Scholar
    • Export Citation
  • 2

    Butson CRMaks CBMcIntyre CC: Sources and effects of electrode impedance during deep brain stimulation. Clin Neurophysiol 117:4474542006

    • Search Google Scholar
    • Export Citation
  • 3

    Damasio ARGrabowski TJBechara ADamasio HPonto LLParvizi J: Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci 3:104910562000

    • Search Google Scholar
    • Export Citation
  • 4

    Depression Guideline Panel: Depression in Primary Care. Volume 2: Treatment of Major Depression. AHCPR Clinical Practice Guidelines No. 5.2. Rockville, MDAgency for Health Care Policy and Research1993

    • Search Google Scholar
    • Export Citation
  • 5

    Dougherty DDWeiss APCosgrove GRAlpert NMCassem EHNierenberg AA: Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for treatment of major depression. J Neurosurg 99:101010172003

    • Search Google Scholar
    • Export Citation
  • 6

    Drevets WCPrice JLSimpson JR JrTodd RDReich TVannier M: Subgenual prefrontal cortex abnormalities in mood disorders. Nature 386:8248271997

    • Search Google Scholar
    • Export Citation
  • 7

    George MSKetter TAParekh PIHorwitz BHerscovitch PPost RM: Brain activity during transient sadness and happiness in healthy women. Am J Psychiatry 152:3413511995

    • Search Google Scholar
    • Export Citation
  • 8

    George MSStallings LESpeer AMNahas ZSpicer KMVincent DJ: Prefrontal repetitive transcranial magnetic stimulation (rTMS) changes relative perfusion locally and remotely. Hum Psychopharmacol Clin Exp 14:1611701999

    • Search Google Scholar
    • Export Citation
  • 9

    Guze SBRobins E: Suicide and primary affective disorders. Br J Psychiatry 117:4374381970

  • 10

    Hamani CMayberg HSnyder BGiacobbe PKennedy SLozano AM: Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting. Clinical article. J Neurosurg 111:120912152009

    • Search Google Scholar
    • Export Citation
  • 11

    Hamani CMayberg HStone SLaxton AHaber SLozano AM: The subcallosal cingulate gyrus in the context of major depression. Biol Psychiatry 69:3013082011

    • Search Google Scholar
    • Export Citation
  • 12

    Kennedy SHGiacobbe PRizvi SJPlacenza FMNishikawa YMayberg HS: Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry 168:5025102011

    • Search Google Scholar
    • Export Citation
  • 13

    Konarski JZKennedy SHSegal ZVLau MABieling PJMcIntyre RS: Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder. J Psychiatry Neurosci 34:1751802009

    • Search Google Scholar
    • Export Citation
  • 14

    Lempka SFJohnson MDMiocinovic SVitek JLMcIntyre CC: Current-controlled deep brain stimulation reduces in vivo voltage fluctuations observed during voltage-controlled stimulation. Clin Neurophysiol 121:212821332010

    • Search Google Scholar
    • Export Citation
  • 15

    Lempka SFMiocinovic SJohnson MDVitek JLMcIntyre CC: In vivo impedance spectroscopy of deep brain stimulation electrodes. J Neural Eng 6:0460012009

    • Search Google Scholar
    • Export Citation
  • 16

    Leon ACKeller MBWarshaw MGMueller TISolomon DACoryell W: Prospective study of fluoxetine treatment and suicidal behavior in affectively ill subjects. Am J Psychiatry 156:1952011999

    • Search Google Scholar
    • Export Citation
  • 17

    Lozano AMMayberg HSGiacobbe PHamani CCraddock RCKennedy SH: Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 64:4614672008

    • Search Google Scholar
    • Export Citation
  • 18

    Malone DA JrDougherty DDRezai ARCarpenter LLFriehs GMEskandar EN: Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry 65:2672752009

    • Search Google Scholar
    • Export Citation
  • 19

    Mayberg HS: Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull 65:1932072003

    • Search Google Scholar
    • Export Citation
  • 20

    Mayberg HSLiotti MBrannan SKMcGinnis SMahurin RKJerabek PA: Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry 156:6756821999

    • Search Google Scholar
    • Export Citation
  • 21

    Mayberg HSLozano AMVoon VMcNeely HESeminowicz DHamani C: Deep brain stimulation for treatment-resistant depression. Neuron 45:6516602005

    • Search Google Scholar
    • Export Citation
  • 22

    Mayberg HSSilva JABrannan SKTekell JLMahurin RKMcGinnis S: The functional neuroanatomy of the placebo effect. Am J Psychiatry 159:7287372002

    • Search Google Scholar
    • Export Citation
  • 23

    Miocinovic SLempka SFRusso GSMaks CBButson CRSakaie KE: Experimental and theoretical characterization of the voltage distribution generated by deep brain stimulation. Exp Neurol 216:1661762009

    • Search Google Scholar
    • Export Citation
  • 24

    Mottaghy FMKeller CEGangitano MLy JThall MParker JA: Correlation of cerebral blood flow and treatment effects of repetitive transcranial magnetic stimulation in depressed patients. Psychiatry Res 115:1142002

    • Search Google Scholar
    • Export Citation
  • 25

    Nobler MSOquendo MAKegeles LSMalone KMCampbell CCSackeim HA: Decreased regional brain metabolism after ECT. Am J Psychiatry 158:3053082001

    • Search Google Scholar
    • Export Citation
  • 26

    Oquendo MACurrier DMann JJ: Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors?. Acta Psychiatr Scand 114:1511582006

    • Search Google Scholar
    • Export Citation
  • 27

    Pardo JVPardo PJRaichle ME: Neural correlates of self-induced dysphoria. Am J Psychiatry 150:7137191993

  • 28

    Seminowicz DAMayberg HSMcIntosh ARGoldapple KKennedy SSegal Z: Limbic-frontal circuitry in major depression: a path modeling metanalysis. Neuroimage 22:4094182004

    • Search Google Scholar
    • Export Citation
  • 29

    Talbot PSCooper SJ: Anterior cingulate and subgenual prefrontal blood flow changes following tryptophan depletion in healthy males. Neuropsychopharmacology 31:175717672006

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 676 660 54
Full Text Views 367 238 16
PDF Downloads 252 174 7
EPUB Downloads 0 0 0
PubMed
Google Scholar