RT Journal
A1 Holtzheimer PE, Kelley ME, Gross RE, et al
T1 SUbcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression
JF Archives of General Psychiatry
JO Archives of General Psychiatry
YR 2012
FD February 1
VO 69
IS 2
SP 150
OP 158
DO 10.1001/archgenpsychiatry.2011.1456
UL http://dx.doi.org/10.1001/archgenpsychiatry.2011.1456
AB Context 
                  Deep brain stimulation (DBS) may be an effective intervention for treatment-resistant depression (TRD), but available data are limited.Objective 
                  To assess the efficacy and safety of subcallosal cingulate DBS in patients with TRD with either major depressive disorder (MDD) or bipolar II disorder (BP).Design 
                  Open-label trial with a sham lead-in phase.Setting 
                  Academic medical center.Patients 
                  Men and women aged 18 to 70 years with a moderate-to-severe major depressive episode after at least 4 adequate antidepressant treatments. Ten patients with MDD and 7 with BP were enrolled from a total of 323 patients screened.Intervention 
                  Deep brain stimulation electrodes were implanted bilaterally in the subcallosal cingulate white matter. Patients received single-blind sham stimulation for 4 weeks followed by active stimulation for 24 weeks. Patients then entered a single-blind discontinuation phase; this phase was stopped after the first 3 patients because of ethical concerns. Patients were evaluated for up to 2 years after the onset of active stimulation.Main Outcome Measures 
                  Change in depression severity and functioning over time, and response and remission rates after 24 weeks were the primary efficacy end points; secondary efficacy end points were 1 year and 2 years of active stimulation.Results 
                  A significant decrease in depression and increase in function were associated with chronic stimulation. Remission and response were seen in 3 patients (18%) and 7 (41%) after 24 weeks (n = 17), 5 (36%) and 5 (36%) after 1 year (n = 14), and 7 (58%) and 11 (92%) after 2 years (n = 12) of active stimulation. No patient achieving remission experienced a spontaneous relapse. Efficacy was similar for patients with MDD and those with BP. Chronic DBS was safe and well tolerated, and no hypomanic or manic episodes occurred. A modest sham stimulation effect was found, likely due to a decrease in depression after the surgical intervention but prior to entering the sham phase.Conclusions 
                  The findings of this study support the long-term safety and antidepressant efficacy of subcallosal cingulate DBS for TRD and suggest equivalent safety and efficacy for TRD in patients with BP.Trial Registration 
                  clinicaltrials.gov Identifier: NCT00367003