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Hyperactivity of the anterior cingulate cortex in depression has led to the use of cingulotomy for some patients with refractory disease. This procedure involves the bilateral ablation of the cingulate bundles, which are white matter tracts just below the anterior cingulate gyrus. In a retrospective study, researchers in Scotland used a sophisticated MRI protocol to identify the location and size of the resulting lesion 1 year after eight patients with highly refractory major depression underwent cingulotomy.
Patients had been ill for a mean of 9.6 years and had failed an average of 11.4 antidepressant treatments from a mean of 5.5 classes, including ECT (mean, 4.5 courses). Participants were moderately to severely depressed before surgery (…