October 17, 2019
Deep brain stimulation of the subcallosal cingulate SCC DBS) appears to offer sustained antidepressant efficacy and long-term safety for patients with treatment-resistant depression for up to 8 years, according to a study published online in The American Journal of Psychiatry.
“Given that patients with treatment-resistant depression are highly susceptible to recurrent depressive episodes, [SCC DBS] is a treatment advance that can mean the difference between getting on with your life or always looking over your shoulder for your next debilitating depressive episode,” said researcher Helen S. Mayberg, MD, professor and founding director of the Nash Family Center for Advanced Circuit Therapeutics at the Icahn School of Medicine at Mount Sinai, New York, NY.
The study used an open-label, long-term follow-up design outcome data to look at 28 patients with either major depressive disorder or bipolar II disorder receiving SCC DBS for 4-8 years in an open-label clinical trial. Participants were in a current depressive episode for 12 months or more with no response to at least four antidepressant treatments, psychotherapy, and electroconvulsive therapy. All participants were implanted with the same subcallosal cingulate deep brain stimulation device by the same surgeon. An initial 17 patients received the implant between 2007 and 2009, and an additional 11 received the implant between 2011 and 2013.
For the first 32 weeks of the study, including the 4 weeks before surgical implantation of the stimulation device, participants met weekly with a study psychiatrist. Afterward, visits occurred every 6 months.
From year 2 through year 8, response rates were maintained at 50% or higher and remission rates were maintained at 30% or higher, according to the study. Three-quarters of participants achieved treatment response for more than half the duration of their participation in the study, and 21% of all participants experienced continuous response from year 1 throughout the rest of the study period.
The procedure was generally safe and well tolerated, with no side effects of acute or chronic stimulation. The rate of medical and surgical complications was consistent with those of other studies of DBS.
“For people suffering from inescapable depression, the possibility that deep brain stimulation can lead to significant and sustained improvement in depressive symptoms over several years will be welcome news,” said researcher Andrea Crowell, MD, an assistant professor at Emory University School of Medicine, Atlanta, GA.
Crowell AL, Riva-Posse P, Holtzheimer PE, et al. Long-term outcomes of subcallosal cingulate deep brain stimulation for treatment-resistant depression. The American Journal of Psychiatry. 2019 October 4;[Epub ahead of print].