DBS Still Looks Like an Option for Refractory Depression

Seven years ago, a small number of patients with highly refractory, unipolar depression were shown to benefit from deep brain stimulation (DBS) of the subcallosal cingulate cortex. Another study later suggested that some patients received a sustained benefit from DBS (JW Psychiatry Mar 16 2009).

Now, researchers have examined changes with sham versus active DBS to the subcallosal cingulate cortex in 7 patients with bipolar depression and 10 patients with unipolar depression (mean number of lifetime episodes, 7; mean duration of current episode, 64 months; mean number of adequate antidepressant trials during the current episode, 6); 94% either had not responded to or had been intolerant of electroconvulsive therapy. Active DBS was continued for 2.5 years. The manufacturer donated the DBS devices.

After a 4-week, single-blind, sham stimulation phase following surgery, depression scores showed a small (14%) but statistically significant decrease compared with baseline values. After 24 weeks, 1 year, and 2 years of active DBS, scores were 44%, 43%, and 70% lower than baseline, respectively. After week 24 of active treatment, sham DBS was begun in three patients; these patients relapsed promptly and were slow to regain benefit following return to active treatment. After 2.5 years, 11 of 12 patients were in remission. Response rates were similar between bipolar and unipolar depressed patients.