Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression

• Published in: Biological psychiatry (1969) Vol. 65; no. 4; pp. 267 - 275
• Main Authors: Malone, Donald A, Dougherty, Darin D, Rezai, Ali R, Carpenter, Linda L, Friehs, Gerhard M, Eskandar, Emad N, Rauch, Scott L, Rasmussen, Steven A, Machado, Andre G, Kubu, Cynthia S, Tyrka, Audrey R, Price, Lawrence H, Stypulkowski, Paul H, Giftakis, Jonathon E, Rise, Mark T, Malloy, Paul F, Salloway, Stephen P, Greenberg, Benjamin D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-02-2009; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Chronic Disease; Cognition - physiology; Deep brain stimulation; Deep Brain Stimulation - adverse effects; Depression; Depressive Disorder - psychology; Depressive Disorder - therapy; Drug Resistance; efficacy; Electrodes, Implanted; Female; Humans; major depression; Male; Medical sciences; Middle Aged; Mood disorders; Neostriatum - physiology; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Treatment Outcome; ventral capsule/ventral striatum; Young Adult; Deep brain stimulation; ventral capsule/ventral striatum; efficacy; major depression; Mood disorder; Treatment resistance; Treatment; Central nervous system; Depression; Basal ganglion; Corpus striatum; Encephalon
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2008.08.029

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.