PICO

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PICO

• Deep brain stimulation for
• treatment resistant depression.
• Clinical reality ?

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• Deep brain stimulation in the treatment of
  depression.
• Acta Psychiatr Scand, 2011
• Blomstedt P et al.

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Subcal.cing. gyrus (no 20) 85 had ECT HDRS -
52 / 1 year 35 remission Capsula interna (no
15) 100 had ECT HDRS -44 / 1 year 40
remission Nucleus accumbens (no 10) 100 had
ECT HDRS - 36 / 1 year 30 remission
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• Subcallosal Cingulate Gyrus Deep Brain
  Stimulation for Treatment-Resistant Depression
• Biological Psychiatry, 2008
• Lozano, et al

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• Increased activity in the subcallosal
  cingulate gyrus

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• Pharmacotherapy
• Transcranial magnetic stimulation
• Electroconvulsive therapy

Altered activity of the SCG

• Deep brain stimulation

Direct modulation of the SCG
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Inclusion

• Severe
• Chronic
• Treatment resistant
• Failure to respond to a minimum of
  four different treatments
• Antidepressant pharmacotherapy of sufficient dose
  and duration
• Evidence-based psychotherapy
• Electroconvulsive therapy

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Exclusion

• comorbid Axis I psychiatric conditions,
• Axis II cluster B diagnosis
• suicidal behaviour within the past year
• concurrent neurological or medical conditions
  that could interfere with the treatment.

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Subjects (n 20)
3 patients received no ECT before
DST All patients received medication
during DST
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• Deep Brain Stimulation for Treatment-Resistant
  Depression Follow-Up After 3 to 6 Years
• Kennedy, et al.
• Am J Psychiatry, 2011

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1 unrelated death 2 suicides 2 lost to follow
up 3 devices removed
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Argument in favour

• Otherwise intractable depression
• Remission rates around 30
• Possible long term benefits

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Arguments against

• No clear target-area
• Invasive procedure
• Battery life
• Open label assessment
• Small N
• Concurrent medication use

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In conclusion

• Experimental therapy
• Clinical studies
• Multidisciplinary teams