Deep Brain Stimulation for Treatment-Resistant Depression causes drastic Improvement, not cure

Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years

Sidney H. Kennedy, M.D., Peter Giacobbe, M.D., M.Sc., Sakina J. Rizvi, B.Sc., Franca M. Placenza, Ph.D., Yasunori Nishikawa, B.Sc., Helen S. Mayberg, M.D., and Andres M. Lozano, M.D., Ph.D.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.

ABSTRACT
OBJECTIVE: A prevalence of at least 30% for treatment-resistant depression has prompted the investigation of alternative treatment strategies. Deep brain stimulation (DBS) is a promising targeted approach involving the bilateral placement of electrodes at specific neuroanatomical sites. Given the invasive and experimental nature of DBS for treatment-resistant depression, it is important to obtain both short-term and long-term effectiveness and safety data. This report represents an extended follow-up of 20 patients with treatment-resistant depression who received DBS to the subcallosal cingulate gyrus (Brodmann’s area 25). METHOD: After an initial 12-month study of DBS, patients were seen annually and at a last follow-up visit to assess depression severity, functional outcomes, and adverse events. RESULTS: The average response rates 1, 2, and 3 years after DBS implantation were 62.5%, 46.2%, and 75%, respectively. At the last follow-up visit (range=3–6 years), the average response rate was 64.3%. Functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit. No significant adverse events were reported during this follow-up, although two patients died by suicide during depressive relapses. CONCLUSIONS: These data suggest that in the long term, DBS remains a safe and effective treatment for treatment-resistant depression. Additional trials with larger samples are needed to confirm these findings.

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