Research Article

Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression

Dolors Puigdemont^a1 c1, Rosario Pérez-Egea^a1, Maria J. Portella^a1, Joan Molet^a2, Javier de Diego-Adeliño^a1, Alexandre Gironell^a3, Joaquim Radua^a4, Beatriz Gómez-Anson^a5, Rodrigo Rodríguez^a2, Maria Serra^a1a6, Cristian de Quintana^a2, Francesc Artigas^a7, Enric Álvarez^a1 and Víctor Pérez^a1

^a1 Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a2 Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a3 Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a4 Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital de les Germanes Hospitalàries Benito Menni, Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a5 Department of Neuroimaging, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a6 Port d'Informació Científica (PIC), Universitat Autònoma de Barcelona (UAB), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

^a7 Department of Neurochemistry and Neuropharmacology, Institut d'Investigacions Biomèdiques de Barcelona, IDIBAPS, Consejo Superior de Investigaciones Cientificas (CSIC), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni M^a. Claret, Barcelona, Catalonia, Spain

Abstract

Deep brain stimulation (DBS) is currently tested as an experimental therapy for patients with treatment-resistant depression (TRD). Here we report on the short- and long-term (1 yr) clinical outcomes and tolerance of DBS in eight TRD patients. Electrodes were implanted bilaterally in the subgenual cingulate gyrus (SCG; Broadman areas 24–25), and stimulated at 135 Hz (90-μs pulsewidth). Voltage and active electrode contacts were adjusted to maximize short-term responses. Clinical assessments included the 17-item Hamilton Depression Rating Scale (HAMD₁₇; primary measure), the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) Scale. In the first week after surgery, response and remission (HAMD ≤7) rates were, respectively 87.5% and 50%. These early responses were followed by an overall worsening, with a response and remission rates of 37.5% (3/8) at 1 month. From then onwards, patients showed a progressive improvement, with response and remission rates of 87.5% and 37.5%, respectively, at 6 months. The corresponding figures at 1 yr were 62.5% and 50%, respectively. Clinical effects were seen in all HAMD subscales without a significant incidence of side-effects. Surgical procedure and post-operative period were well-tolerated for all patients. This is the second independent study on the use of DBS of the SCG to treat chronic depression resistant to current therapeutic strategies. DBS fully remitted 50% of the patients at 1 yr, supporting its validity as a new therapeutic strategy for TRD.

(Received April 13 2011)

(Reviewed April 24 2011)

(Revised May 28 2011)

(Accepted June 13 2011)

(Online publication July 22 2011)

Key Words:

• Deep brain stimulation;
• subgenual cingulate gyrus;
• treatment-resistant depression

Correspondence:

^c1 Address for correspondence: Dr D. Puigdemont, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni M^a. Claret 167, 08025 Barcelona, Catalonia, Spain. Tel.: 34 935537840 (ext. 8509) Fax: 34 935537842 Email: mpuigdemont@santpau.cat