Rapid effects of deep brain stimulation for treatment-resistant major depression

Thomas E. Schlaepfer, Bettina H. Bewernick, Sarah Kayser, Burkhard Mädler, Volker A. Coenen

Research output: Contribution to journalArticlepeer-review

320 Scopus citations

Abstract

Background: Treatment-resistant major depressive disorder is a prevalent and debilitating condition. Deep brain stimulation to different targets has been proposed as a putative treatment. Methods: In this pilot study, we assessed safety and efficacy of deep brain stimulation to the supero-lateral branch of the medial forebrain bundle in seven patients with highly refractory depression. Primary outcome criterion was severity of treatment-resistant major depressive disorder as assessed with the Montgomery-Åsberg Depression Rating Scale. General psychopathologic parameters, social functioning, and tolerance were assessed with standardized scales, the Global Assessment of Functioning scale, quality of life (Short-Form Health Survey Questionnaire), and neuropsychological tests. Results: All patients showed strikingly similar intraoperative effects of increased appetitive motivation. Six patients attained the response criterion; response was rapid - mean Montgomery-Åsberg Depression Rating Scale of the whole sample was reduced by>50% at day 7 after onset of stimulation. At last observation (12-33 weeks), six patients were responders; among them, four were classified as remitters. Social functioning (Global Assessment of Functioning) improved in the sample as a whole from serious to mild impairment. Mean stimulation current was 2.86 mA; all side effects (strabismus at higher stimulation current, one small intracranial bleeding during surgery, infection at the implanted pulse generator site) could be resolved at short term. Conclusions: These preliminary findings suggest that bilateral stimulation of the supero-lateral branch of the medial forebrain bundle may significantly reduce symptoms in treatment-resistant major depressive disorder. Onset of antidepressant efficacy was rapid (days), and a higher proportion of the population responded at lower stimulation intensities than observed in previous studies.

Original languageEnglish (US)
Pages (from-to)1204-1212
Number of pages9
JournalBiological psychiatry
Volume73
Issue number12
DOIs
StatePublished - Jun 15 2013
Externally publishedYes

Keywords

  • Affective disorders
  • deep brain stimulation
  • diffusion tensor imaging
  • medial forebrain bundle
  • rapid antidepressant effects
  • treatment-resistant major depression

ASJC Scopus subject areas

  • Biological Psychiatry

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