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Deep brain stimulation may improve treatment-resistant depression symptoms

Helen S. Mayberg

Deep brain stimulation of the subcallosal cingulate white matter provided antidepressant effects in most patients with treatment-resistant depression, according to recently published study data.

“DBS [deep brain stimulation] is an experimental intervention tested in an extremely treatment-resistant group of depressed patients,” Helen S. Mayberg, MD, professor of neurology at the Icahn School of Medicine at Mount Sinai, told Healio Psychiatry. “A majority of patients responded to the treatment, albeit at different rates. Most importantly, once better, they tended to stay better over the long-term. This sustained response with ongoing DBS is something not typical of other treatments.”

According to Mayberg and colleagues, DBS of the subcallosal cingulate has been investigated as a potential treatment for severe and highly refractory major depression since 2005. Results from small, open-label trials that included 193 participants showed a response rate of approximately 50% to 60% to this treatment, as well as remission rates of 30% to 40% during the same period. However, results from a sham-controlled trial of DBS did not indicate significant efficacy.

Mayberg and colleagues collected long-term follow-up data for 28 patients from a single-center, open-label clinical trial of DBS of the subcallosal cingulate for treatment-resistant depression. Of the participants, 20 patients were diagnosed with major depressive disorder and eight patients with bipolar II disorder. All patients received treatment for 4 to 8 years.

The researchers reported response and remission rates were maintained at 50% or greater and 30% or greater, respectively, through years 2 to 8 of follow-up. Nearly 75% of participants met the treatment-response criterion for more than half of their study participation, and 21% of all participants demonstrated continuous response to treatment from the first year onward.

The researchers considered the DBS procedure generally safe and well tolerated, with no adverse events of acute or chronic stimulation. Medical or surgical complication rates were consistent with those observed in studies of DBS for other indications, and no suicides occurred.

“This level of treatment-resistant depression has a high degree of disability and mortality,” Mayberg said. “Patients who have failed most available treatments, including ECT, have no real options. The maintenance of a sustained response over many years with ongoing DBS is encouraging and requires further study.” – by Joe Gramigna

Disclosures: Mayberg reports consulting and intellectual licensing fees from Abbott. Please see the study for all other authors’ relevant financial disclosures.