Abstract
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.
Highlights
Deep brain stimulation (DBS) is being investigated as a potential therapy for treatment-resistant depression (TRD)
We offer a single lab perspective (Emory University, Atlanta GA, USA) from 8 years of studies of subcallosal cingulate (SCC) deep brain stimulation (DBS) for TRD, highlighting the key clinical features of patient selection and the DBS-mediated therapeutic response in this target (Table 1; clinicaltrials.gov NCT00367003, NCT01984710)
Patients with the best response to SCC DBS are those who have a history of treatment-responsive depressive episodes with good inter-episode recovery, but undergo a malignant transformation and no longer respond to standard therapies
Summary
Deep brain stimulation (DBS) is being investigated as a potential therapy for treatment-resistant depression (TRD). Given the small number of researchers with firsthand experience with DBS for depression, open dialog to maximize our collective experiential knowledge of this treatment is encouraged. Towards this goal, we offer a single lab perspective (Emory University, Atlanta GA, USA) from 8 years of studies of SCC DBS for TRD, highlighting the key clinical features of patient selection and the DBS-mediated therapeutic response in this target (Table 1; clinicaltrials.gov NCT00367003, NCT01984710). Patients’ descriptions of their depression often include themes of psychic pain, darkness, being weighted down, or being in a hole This is accompanied by pronounced psychomotor slowing, non-fluent, monotonous speech, and limited affective range. Chronicity, treatment resistance, and functional impairment define overall disease severity in addition to total symptom burden
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