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Published Online: 1 May 2011

Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years

Sidney H. Kennedy, M.D., Peter Giacobbe, M.D., M.Sc., Sakina J. Rizvi, B.Sc., Franca M. Placenza, Ph.D., Yasunori Nishikawa, B.Sc., Helen S. Mayberg, M.D., and Andres M. Lozano, M.D., Ph.D.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 168, Number 5
https://doi.org/10.1176/appi.ajp.2010.10081187
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Abstract

Objective:

A prevalence of at least 30% for treatment-resistant depression has prompted the investigation of alternative treatment strategies. Deep brain stimulation (DBS) is a promising targeted approach involving the bilateral placement of electrodes at specific neuroanatomical sites. Given the invasive and experimental nature of DBS for treatment-resistant depression, it is important to obtain both short-term and long-term effectiveness and safety data. This report represents an extended follow-up of 20 patients with treatment-resistant depression who received DBS to the subcallosal cingulate gyrus (Brodmann's area 25).

Method:

After an initial 12-month study of DBS, patients were seen annually and at a last follow-up visit to assess depression severity, functional outcomes, and adverse events.

Results:

The average response rates 1, 2, and 3 years after DBS implantation were 62.5%, 46.2%, and 75%, respectively. At the last follow-up visit (range=3–6 years), the average response rate was 64.3%. Functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit. No significant adverse events were reported during this follow-up, although two patients died by suicide during depressive relapses.

Conclusions:

These data suggest that in the long term, DBS remains a safe and effective treatment for treatment-resistant depression. Additional trials with larger samples are needed to confirm these findings.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 168 • Number 5 • May 2011
Pages: 502 - 510
PubMed: 21285143

History

Received: 20 August 2010
Revision received: 2 November 2010
Accepted: 8 November 2010
Published online: 1 May 2011
Published in print: May 2011

Authors

Affiliations

Sidney H. Kennedy, M.D.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Peter Giacobbe, M.D., M.Sc.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Sakina J. Rizvi, B.Sc.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Franca M. Placenza, Ph.D.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Yasunori Nishikawa, B.Sc.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Helen S. Mayberg, M.D.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Andres M. Lozano, M.D., Ph.D.
From the Department of Psychiatry and the Division of Neurosurgery, Department of Surgery, University Health Network, Toronto; the Departments of Psychiatry, Pharmaceutical Sciences, and Neuroscience, University of Toronto; and the Departments of Psychiatry and Neurology, Emory University School of Medicine, Atlanta.
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Notes

Address correspondence and reprint requests to Dr. Kennedy, Department of Psychiatry, University Health Network, Rm. 222, Eaton North Wing 8th Floor, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada; [email protected] (e-mail).

Funding Information

Dr. Kennedy has received honoraria or grant funding from AstraZeneca, Biovail, Boehringer-Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen-Ortho, Lundbeck, Merck Frosst, Pfizer, Servier, and St. Jude Medical. Dr. Giacobbe has received honoraria or grant funding from AstraZeneca, Canadian Academy of Geriatric Psychiatry, Canadian Institutes of Health Research, Eli Lilly Canada, Michael J. Fox Foundation for Parkinson's Research, St. Jude Medical, and University Health Networks Department of Psychiatry. Dr. Lozano has served as a consultant to St. Jude Medical and Medtronic and is an intellectual property holder and licensor in the field of deep brain stimulation. Dr. Mayberg has served as a consultant for and receives intellectual property licensing fees from St. Jude Medical. The other authors report no financial relationships with commercial interests.Supported in part by the Department of Psychiatry at University Health Network.

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