Characterizing the therapeutic response to deep brain stimulation for treatment-resistant depression: a single center long-term perspective

The number of depressed patients treated with deep brain stimulation (DBS) is relatively small. However, experience with this intervention now spans more than 10 years at some centers, with study subjects typically monitored closely. Here we describe one center’s evolving impressions regarding optimal patient selection for DBS of the subcallosal cingulate (SCC) as well as observations of short- and long-term patterns in antidepressant response and mood reactivity. A consistent time course of therapeutic response with distinct behavioral phases is observed. Early phases are characterized by changes in mood reactivity and a transient and predictable worsening in self ratings prior to stabilization of response. It is hypothesized that this characteristic recovery curve reflects the timeline of neuroplasticity in response to DBS. Further investigation of these emerging predictable psychiatric, biological, and psychosocial patterns will both improve treatment optimization and enhance understanding and recognition of meaningful DBS antidepressant effects.

[1]  Megan M. Filkowski,et al.  Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. , 2012, Archives of general psychiatry.

[2]  C. Hamani,et al.  Deep brain stimulation for treatment-resistant depression. , 2010, The American journal of psychiatry.

[3]  Md Kamal Hosain,et al.  Closed loop deep brain stimulation: an evolving technology , 2014, Australasian Physical & Engineering Sciences in Medicine.

[4]  J F Stein,et al.  Post‐operative progress of dystonia patients following globus pallidus internus deep brain stimulation , 2003, European journal of neurology.

[5]  R. Ramasubbu,et al.  Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study. , 2013, Journal of psychiatry & neuroscience : JPN.

[6]  Helen S. Mayberg,et al.  Multimodal Approaches to Define Network Oscillations in Depression , 2015, Biological Psychiatry.

[7]  Rachel Sharp,et al.  The Hamilton Rating Scale for Depression. , 2015, Occupational medicine.

[8]  Felipe Fregni,et al.  A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. , 2008, The international journal of neuropsychopharmacology.

[9]  R. Bagby,et al.  The Hamilton Depression Rating Scale: has the gold standard become a lead weight? , 2004, The American journal of psychiatry.

[10]  Benjamin D. Greenberg,et al.  What's in a “Smile?” Intra-operative Observations of Contralateral Smiles Induced by Deep Brain Stimulation , 2004, Neurocase.

[11]  B. Mädler,et al.  Rapid Effects of Deep Brain Stimulation for Treatment-Resistant Major Depression , 2013, Biological Psychiatry.

[12]  Sidney H. Kennedy,et al.  Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. , 2011, The American journal of psychiatry.

[13]  V. Sturm,et al.  Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy , 2012, Neuropsychopharmacology.

[14]  Christopher W Mount,et al.  Neuronal Activity Promotes Oligodendrogenesis and Adaptive Myelination in the Mammalian Brain , 2014, Science.

[15]  Rajesh Pahwa,et al.  Effect and Time Course of Deep Brain Stimulation of the Globus Pallidus and Subthalamus on Motor Features of Parkinson's Disease , 2000, Clinical neuropharmacology.

[16]  P. Bech,et al.  QUANTITATIVE RATING OF DEPRESSIVE STATES , 1975, Acta psychiatrica Scandinavica.

[17]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[18]  J. Rothwell,et al.  Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms. , 2011, Brain : a journal of neurology.

[19]  D. Kondziolka,et al.  A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Chronic Treatment-Resistant Depression , 2015, Biological Psychiatry.

[20]  Clement Hamani,et al.  Deep Brain Stimulation Reverses Anhedonic-Like Behavior in a Chronic Model of Depression: Role of Serotonin and Brain Derived Neurotrophic Factor , 2012, Biological Psychiatry.

[21]  Michael X. Cohen,et al.  Nucleus Accumbens Deep Brain Stimulation Decreases Ratings of Depression and Anxiety in Treatment-Resistant Depression , 2010, Biological Psychiatry.

[22]  P. House A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression , 2012 .

[23]  A. Kupsch,et al.  Antidepressant effects after short-term and chronic stimulation of the subgenual cingulate gyrus in treatment-resistant depression , 2013, Experimental Neurology.

[24]  A. Lozano,et al.  Deep Brain Stimulation for Treatment-Resistant Depression , 2005, Neuron.

[25]  Clement Hamani,et al.  A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. , 2012, Journal of neurosurgery.

[26]  Pedram Afshar,et al.  A translational platform for prototyping closed-loop neuromodulation systems , 2013, Front. Neural Circuits.

[27]  Justin K. Rajendra,et al.  Defining Critical White Matter Pathways Mediating Successful Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Depression , 2014, Biological Psychiatry.

[28]  S. Rauch,et al.  Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression , 2009, Biological Psychiatry.

[29]  Paul E Holtzheimer,et al.  Frontal Theta Cordance Predicts 6-Month Antidepressant Response to Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Depression: A Pilot Study , 2012, Neuropsychopharmacology.

[30]  Michael X. Cohen,et al.  Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression , 2008, Neuropsychopharmacology.

[31]  A. Lozano,et al.  Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression , 2008, Biological Psychiatry.

[32]  D. Puigdemont,et al.  Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression. , 2012, The international journal of neuropsychopharmacology.