Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression

Biol Psychiatry. 2009 Feb 15;65(4):267-75. doi: 10.1016/j.biopsych.2008.08.029. Epub 2008 Oct 8.


Background: We investigated the use of deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) for treatment refractory depression.

Methods: Fifteen patients with chronic, severe, highly refractory depression received open-label DBS at three collaborating clinical sites. Electrodes were implanted bilaterally in the VC/VS region. Stimulation was titrated to therapeutic benefit and the absence of adverse effects. All patients received continuous stimulation and were followed for a minimum of 6 months to longer than 4 years. Outcome measures included the Hamilton Depression Rating Scale-24 item (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Global Assessment of Function Scale (GAF).

Results: Significant improvements in depressive symptoms were observed during DBS treatment. Mean HDRS scores declined from 33.1 at baseline to 17.5 at 6 months and 14.3 at last follow-up. Similar improvements were seen with the MADRS (34.8, 17.9, and 15.7, respectively) and the GAF (43.4, 55.5, and 61.8, respectively). Responder rates with the HDRS were 40% at 6 months and 53.3% at last follow-up (MADRS: 46.7% and 53.3%, respectively). Remission rates were 20% at 6 months and 40% at last follow-up with the HDRS (MADRS: 26.6% and 33.3%, respectively). The DBS was well-tolerated in this group.

Conclusions: Deep brain stimulation of the VC/VS offers promise for the treatment of refractory major depression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease
  • Cognition / physiology
  • Deep Brain Stimulation* / adverse effects
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy*
  • Drug Resistance
  • Electrodes, Implanted
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neostriatum / physiology*
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Recurrence
  • Treatment Outcome
  • Young Adult