Deep brain stimulation of the subcallosal cingulate gyrus in patients with treatment-resistant depression: A double-blinded randomized controlled study and long-term follow-up in eight patients

J Affect Disord. 2018 Feb;227:521-529. doi: 10.1016/j.jad.2017.11.024. Epub 2017 Nov 8.

Abstract

Background: Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) is an experimental approach in treatment-resistant depression (TRD). Short-term results of efficacy in DBS are incongruent and studies investigating long-term effects are warranted.

Methods: We assessed efficacy of SCG-DBS in eight patients randomized into a delayed-onset group (sham-DBS four weeks) and a non-delayed-onset group. The primary outcome measure was improvement on the Hamilton Depression Rating-Scale (HAMD-24-item-version). Response was defined as HAMD-24 reduction of at least 50% compared to baseline. Assessment was double-blind for a period of eight weeks and after 6,- 12,- 24,- and 28,- months open-label.

Results: The average improvement in HAMD-24 scores after 6,- 12,- and 24-months were 34%, 25%, and 37%. After 6 months, HAMD-24 revealed a significant difference (P = .022) and 37.5% of the patients were responders. After 12 months, HAMD-24 scores dropped, but no significant difference was observed. After 24 months, a significant improvement was found (P = .041). After the four weeks lasting sham vs. DBS-ON period, there was no group difference (P = .376) in HAMD-24 and patients did not improve during sham stimulation. Patients were followed until 28 months and two up to 4 years under SCG-DBS and average response rate was 51%, whereas two patients were remitters (33,3%).

Limitations: The small sample size limited the statistical power and external validity.

Conclusions: Long-term improvement after SCG-DBS revealed a stable effect. There was no significant difference in response rates between the delayed and non-delayed-onset group. DBS for TRD remains experimental and longitudinal investigations of large samples are needed.

Keywords: Affective disorders; Cg25; Deep brain stimulation; Depression; Subcallosal cingulate gyrus; Treatment-resistant.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Deep Brain Stimulation / methods*
  • Depressive Disorder, Treatment-Resistant / psychology*
  • Depressive Disorder, Treatment-Resistant / therapy*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Gyrus Cinguli*
  • Humans
  • Male
  • Middle Aged
  • Sample Size
  • Time Factors
  • Treatment Outcome