Researchers from the Cleveland Clinic, Brown University, and Massachusetts General Hospital are reporting that deep brain stimulation (DBS) could be an option for people with treatment resistant major depression.
According to the World Health Organization major depression is the top cause of disability worldwide. Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery. However, statistics have revealed that the suicide rate in people with major depression is as high as 15 percent.
DBS success is relies on the surgical team's ability to precisely pinpoint the specific brain area for stimulation. The advantage of DBS is that it is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation.
Ali R. Rezai, MD, director of Cleveland Clinic's Center for Neurological Restoration, and the researchers were motivated by DBS success in the treatment of the tremors linked with Parkinson's and movement disorders like dystonia and essential tremor.
"Starting in 2001, we began treating patients with obsessive compulsive disorder (OCD) with promising outcomes. These findings resulted in the initiation of a subsequent trial for patients with severe and medication intractable major depression, starting in 2003. The preliminary results of research undertaken between 2003 and 2005 indicated that bilateral DBS of the anterior limb of the internal capsule holds promise for the treatment of intractable major depression, which led to the more extensive research results being presented today," stated Rezai.
The researcher recruited 15 chronic and severely depressed patients in this study, who had failed multiple medication trials, as well as psychotherapy and electroconvulsive therapy (ECT). These highly intractable and often suicidal patients underwent bilateral DBS implantation in the ventral internal capsule/ventral striatum (VC/VS) at the three institutions.
The researchers followed the Montgomery-Asberg Depression Rating Scale (MADRAS) as the primary outcome scale, among many scales, including those assessing overall quality of life, functioning and cognitive status.
The results indicated that the responses were seen in seven (47 percent) of 15 patients at six months, five (45.5 percent) of 11 at 12 months, and eight (53.3 percent) of 15 at last follow-up. They researchers also noted long-term improvement in depression severity, functioning, and quality of life. It showed an improvement in measures of short-term memory. Besides, there were no hemorrhages, infections or other neurological deficits.
"This research substantiates our earlier findings, which indicate that bilateral DBS of the anterior limb of the internal capsule holds promise and hope for select patients suffering from severe and treatment resistant major depression," stated Rezai.
The results of the current study, Deep Brain Stimulation for the Treatment of Depression: Long-Term Outcomes from a Prospective Multi-Center Trial, will be presented during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago.