Highlights
- •Deep brain stimulation (DBS) of the medial forebrain bundle in treatment-resistant depression led to antidepressant effects.
- •Antidepressant effects were rapid and sustained for up to four years in a small sample.
- •Timeline analysis could reflect more adequately patient's overall gain throughout the study than endpoint-analyses.
- •Study design (endpoint selection, response, placebo, outcome measure) in DBS for treatment-resistant depression is discussed.
Abstract
Background
Deep brain stimulation (DBS) of the supero-lateral branch of the medial forebrain
bundle (slMFB) in treatment-resistant depression (TRD) is associated with acute antidepressant
effects.
Objective
Long-term clinical effects including changes in quality of life, side effects and
cognition as well as long-term data covering four years are assessed.
Methods
Eight TRD patients were treated with DBS bilateral to the slMFB. Primary outcome measure
was a 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) (response)
and remission (MADRS <10) at 12 months compared to baseline. Secondary measures were
anxiety, general functioning, quality of life, safety and cognition assessed for 4
years. Data is reported as conventional endpoint-analysis and as area under the curve
(AUC) timeline analysis.
Results
Six of eight patients (75%) were responders at 12 months, four patients reached remission.
Long-term results revealed a stable effect up to four years. Antidepressant efficacy
was also reflected in the global assessment of functioning. Main side effect was strabismus
at higher stimulation currents. No change in cognition was identified. AUC analysis
revealed a significant reduction in depression for 7/8 patients in most months.
Conclusions
Long-term results of slMFB-DBS suggest acute and sustained antidepressant effect;
timeline analysis may be an alternative method reflecting patient's overall gain throughout
the study. Being able to induce a rapid and robust antidepressant effect even in a
small, sample of TRD patients without significant psychiatric comorbidity, render
the slMFB an attractive target for future studies.
Keywords
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Article info
Publication history
Published online: February 08, 2017
Accepted:
January 23,
2017
Received in revised form:
January 12,
2017
Received:
August 12,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
