|
||||
 |
The Voice of the American Psychiatric Association and the Psychiatric Community
| BACK TO NEWSLETTER | :: | CURRENT ISSUE | :: | PN ARCHIVES | :: | NEWS ALERT | :: | CONTACT US |
|
 |
 |
 |
Findings on Deep Brain Stimulation Open Doors to Rethinking Depression Treatment Deep brain stimulation (DBS) may be an effective intervention for treatment-resistant depression, offering a way to reconceptualize depression and its treatment, said Helen Mayberg, M.D., at APA’s annual meeting today. She was one of the meeting’s “Frontiers in Science” lecturers. Mayberg, a professor of psychiatry and neurology and the Dorothy Fuqua Chair in Psychiatry Imaging and Therapeutics in the School of Medicine at Emory University, described recent research and outlined future challenges regarding the use of DBS for treatment-resistant depression. Her research program uses neuroimaging to study brain mechanisms mediating depression pathogenesis and antidepressant treatment response, and she has pioneered the development of deep brain stimulation for treatment-resistant depressed patients. Mayberg told psychiatrists at the meeting that neuromodulation of brain circuits implicated in depression using DBS as a new strategy has been facilitated by recent advances in stereotaxic neurosurgery, experience with stimulation of brain circuits in other neurological disorders, and the availability of structural/functional imaging to guide the use of DBS. And she emphasized the convergence of evidence indicating the role of the subcallosal cingulate in many of the symptoms of depression and described research using DBS to target that area. In a recent study in the Archives of General Psychiatry, Mayberg and colleagues assessed the efficacy and safety of subcallosal cingulate DBS in patients with treatment-resistant depression with either major depressive disorder (MDD) or bipolar II disorder (BP). Ten patients with MDD and seven with BP were enrolled from a total of 323 patients screened. Deep brain stimulation electrodes were implanted bilaterally in the subcallosal cingulate white matter. Patients received single-blind sham stimulation for four weeks followed by active stimulation for 24 weeks. Patients then entered a single-blind discontinuation phase; this phase was stopped after the first three patients because of ethical concerns. Patients were evaluated for up to two years after the onset of active stimulation. A significant decrease in depression and increase in function were associated with chronic stimulation. Remission and response (respectively) were seen in three patients and seven patients after 24 weeks; five and five patients after 1 year; and seven and 11 patients after two years of active stimulation. No patient achieving remission experienced a spontaneous relapse. Efficacy was similar for patients with MDD and those with BP. The study was titled, “Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Unipolar and Bipolar Depression.” |
|
Copyright © 2012 American Psychiatric Association. All rights reserved.