Deep brain stimulation for treatment-resistant depression

Helen S. Mayberg; Andres M. Lozano; Valerie Voon; Heather E. McNeely; David Seminowicz; Clement Hamani; Jason M. Schwalb; Sidney H. Kennedy

doi:10.1016/j.neuron.2005.02.014

Deep brain stimulation for treatment-resistant depression

Helen S. Mayberg, Andres M. Lozano, Valerie Voon, Heather E. McNeely, David Seminowicz, Clement Hamani, Jason M. Schwalb, Sidney H. Kennedy

Research output: Contribution to journal › Article › peer-review

3178 Scopus citations

Abstract

Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.

Original language	English
Pages (from-to)	651-660
Number of pages	10
Journal	Neuron
Volume	45
Issue number	5
DOIs	https://doi.org/10.1016/j.neuron.2005.02.014
State	Published - 3 Mar 2005
Externally published	Yes

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10.1016/j.neuron.2005.02.014

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title = "Deep brain stimulation for treatment-resistant depression",

abstract = "Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.",

author = "Mayberg, {Helen S.} and Lozano, {Andres M.} and Valerie Voon and McNeely, {Heather E.} and David Seminowicz and Clement Hamani and Schwalb, {Jason M.} and Kennedy, {Sidney H.}",

note = "Funding Information: This study was supported by a distinguished Investigator Award to H.S.M. from the National Alliance for Research in Schizophrenia and Depression (NARSAD). We thank Kari Fulton for patient screening and coordination; Doug Hussey and Alvina Ng for acquisition of the PET studies; Jonathan Dostrovsky and William Hutchison for intraoperative electrophysiological studies; Jean Saint-Cyr for assistance with MR imaging; and Stanley Mayberg and Paul Holzheimer for critical review of the manuscript. ",

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AU - Mayberg, Helen S.

AU - Lozano, Andres M.

AU - Voon, Valerie

AU - McNeely, Heather E.

AU - Seminowicz, David

AU - Hamani, Clement

AU - Schwalb, Jason M.

AU - Kennedy, Sidney H.

N1 - Funding Information: This study was supported by a distinguished Investigator Award to H.S.M. from the National Alliance for Research in Schizophrenia and Depression (NARSAD). We thank Kari Fulton for patient screening and coordination; Doug Hussey and Alvina Ng for acquisition of the PET studies; Jonathan Dostrovsky and William Hutchison for intraoperative electrophysiological studies; Jean Saint-Cyr for assistance with MR imaging; and Stanley Mayberg and Paul Holzheimer for critical review of the manuscript.

PY - 2005/3/3

Y1 - 2005/3/3

N2 - Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.

AB - Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.

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Deep brain stimulation for treatment-resistant depression

Abstract

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