PICO Deep brain stimulation for treatment resistant depression

PICO Deep brain stimulation for treatment resistant depression. Clinical reality ?

Deep brain stimulation in the treatment of depression. Acta Psychiatr Scand, 2011 Blomstedt P et al.

Subcal. cing. gyrus (no 20) 85% had ECT HDRS - 52% / 1 year 35% remission Capsula interna (no 15) 100% had ECT HDRS -44% / 1 year 40% remission Nucleus accumbens (no 10) 100% had ECT HDRS - 36% / 1 year 30% remission

§ Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment. Resistant Depression § Biological Psychiatry, 2008 § Lozano, et al

Increased activity in the subcallosal cingulate gyrus

§ Pharmacotherapy § Transcranial magnetic stimulation § Electroconvulsive therapy Altered activity of the SCG § Deep brain stimulation Direct modulation of the SCG

Inclusion Severe Chronic Treatment resistant Failure to respond to a minimum of four different treatments § Antidepressant pharmacotherapy of sufficient dose and duration § Evidence-based psychotherapy § Electroconvulsive therapy

Exclusion § comorbid Axis I psychiatric conditions, § Axis II cluster B diagnosis § suicidal behaviour within the past year § concurrent neurological or medical conditions that could interfere with the treatment.

Subjects (n = 20) Male/female 9/11 Age at Enrollment (years) 47. 4 ± 10. 4 Age of Onset of MDD (years) 27. 1 ± 8. 3 Length of Current Episode (years) 6. 9 ± 5. 6 Number of Lifetime MDE (n) 3. 9 ± 3. 1 Received ECT (n) 17/20 Baseline HRSD-17 24. 4 ± 3. 5 3 patients received no ECT before DST All patients received medication during DST

Adverse Effect Number of Patients Wound Infection and Hardware removal 3 Reinsertion of DBS Hardware 1 Wound Infection Managed with Antibiotics Alone 1 Perioperative Seizure 1 Worsening Mood/Irritability 2 Perioperative Headache 4 Pain at Pulse Generator Site 1 No Adverse Effects 7