Deep Brain Stimulation & Treatment-Resistant Depression

About 1% to 3% of the United States population has treatment-resistant depression (TRD), a costly and disabling disorder. In recent clinical trials, deep brain stimulation (DBS) has been used on various neuroanatomic targets in the brain in an effort to treat TRD. Helen S. Mayberg, MD, and colleagues in Toronto published a report in 2005 which demonstrated encouraging results when using DBS in the subcallosal cingulate (SCC) matter, an area of the brain that has been dubbed “Area 25.” In this study, patients with TRD who had DBS experienced antidepressant response rates in excess of 50% when assessed 6 and 12 months after the procedure. “Although results were encour­aging, this initial pilot study was limited by being an open-label investigation,” says Dr. Mayberg. In an effort to garner more long-term efficacy and safety data on SCC DBS for TRD and extend experience with the procedure, Dr. Mayberg teamed up with Paul E. Holtzheimer, MD, and colleagues at Emory University and published a study in the February 2012 Archives of General Psychiatry involving 17 TRD patients who received the procedure. The analysis also aimed to address whether there was an antidepressant effect associated with sham SCC DBS and if the procedure was safe and effective in patients with treatment-resistant bipolar depression. (see also, Navigating Patients Through Depression) Analyzing the New Data on DBS In the study by Drs. Holtzheimer and Mayberg, participants received single-blind sham SCC DBS for 4 weeks, in which patients did not know if the DBS system was on or off. This was followed by active stimulation for 24 weeks. Patients were evaluated for up to 2...