Deep-brain stimulation has provided yearlong relief of symptoms of severe depression for patients who had been refractory to a variety of other therapies. Ali R. Rezai, MD, of the Cleveland Clinic reported that eight of 16 patients enrolled in the study showed at least 50% improvement in depression scores at an interview before his presentation at the American Association of Neurological Surgeons. According to Dr. Rezai, “[Responders] had significant improvement in quality of life, returning back to work, getting engaged, dating.” The study’s focus was on patients that had disabling severe major depression for over five years and had not had any response to at least three different classes of antidepressants at the highest dosage levels. The following is an excerpt of an article from Medpage Today that reviews the study’s findings:
The study enrolled 17 patients overall, with one patient not yet completing a year of treatment when the data were analyzed.
Patients had severe and disabling major depression lasting at least five years without response to at least three classes of antidepressants titrated to the highest tolerated doses. All patients also failed combined therapy with at least two augmentation agents and multiple electroconvulsive therapy trials.
Those considered to be at imminent risk of suicide were excluded, as were patients with current or past psychotic disorders, associated neurological disorder, any significant brain imaging abnormality, substance abuse, history of severe personality disorder, coagulopathy, or other medical problems that could increase the risk of surgery.
Treatment involved placement of a Medtronic Soletra implantable pulse generator, a pacemaker-like device used in deep brain stimulation for Parkinson’s disease. Bilateral leads were placed in the ventral portion of the anterior limb of the internal capsule and ventral striatum with high-resolution MRI targeting.
Each electrode contact was 3 mm long with 4 mm of spacing or insulation between contacts. The diameter and other physical properties were the same as the common electrodes used in deep brain stimulation for movement disorders, Dr. Rezai said.