The strongest evidence exists for Broadman Area 25 in the subcallosal cingulate gyrus (SCG) as target for deep brain stimulation in treatment resistant depression. This area in the brain is depicted in the figure above and is from the most important publication about DBS and depression in Neuron march 2005 by Helen Mayberg. Functional neuroimaging as well as antidepressant treatment effects suggest that this area plays an important role in modulating negative mood states. A decrease in activity is reported with clinical response to antidepressants and electroconvulsive therapy (ECT).
But depression is not a disease of a single brain region nor neurotransmitter system. It is now generally viewed as a systems-level disorder affecting integrated pathways linking select cortical, subcortical, and limbic brain regions with their related neurotransmitter systems.
Suggestions of other brain localizations for treatment with DBS for depression comes from case reports with DBS for other indications than depression. These localizations have been described in a peer reviewed article with excelent graphics.
In a recent study done by the “Mayberg group”, Toronto, Canada, the autors compared the location of the electrode contacts in responders and nonresponders to DBS of the subcallosal cingulate gyrus (SCG) and correlated the results with clinical outcome to help in identifying the optimal target within the region.
On postoperative MRI scans the researchers did complicated mapping procedures to pin point the locations of the active contacts on the implanted electrodes. There was no difference when the right and left electrodes were compared in patients. So both electrodes were exactly placed on each side (hemisphere). The only significant difference they found between responders and nonresponders was that electrodes in patients who responded were in a slightly more ventral position relative to the anatomical landmarks used in the medial prefrontal lobe. This difference between responders and nonresponders did not exceed 1,5 mm. The authors is not likely to be of clinical significance, according to the authors. This small difference is probably unimportant compared to the clinical features of the patient for the outcome of the DBS procedure in depression. Another limiting factor on this research is the small sample size, in larger groups these results might differ.
What we can conclude based on our findings is that within the small targeted region of the SCG, the location of the electrode contacts did not determine outcome.
This article also describes a detailed method for a more standardized method for targeting the SCG with DBS for depression. This is to technical to reproduce in this post but those working with DBS for depression should have a look at this procedure. From this study it is still not clear whether DBS of other brain areas might be more superior in efficacy. And is brain area more important than clinical features of the patient or do the areas differ for different types of depression? All very interesting questions and topic for more research on DBS.
Hamani, C., Mayberg, H., Snyder, B., Giacobbe, P., Kennedy, S., & Lozano, A. (2009). Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting Journal of Neurosurgery, 111 (6), 1209-1215 DOI: 10.3171/2008.10.JNS08763
Popularity: 6% [?]
No related posts.
Related posts brought to you by Yet Another Related Posts Plugin.
You realize of course “deep brain stimulation” is considered abuse. I am frankly amazed you would dare promo this dangerous rubbish on the internet.
It’s this sort of thing that besmirches the efforts of all therapists who don’t engage in patient abuse.
As someone who not only has training as a therapist but also treatment resistant depression, I have to say that this does not seem to be abuse to me. If this procedure could give me relief after 38 years of major depression, I would consider it a blessing.
I find the response of Bretha Muse to illustrate one being sadly ill informed and lacking compassion whether from the standpoint of a professional, patient or other.
As a very, very long time support person and caregiver I advocate for considering the least invasive treatment options to be considered first such as nutrition, holistic approaches as well as talk therapies etc. To consider DBS and/or medications, ECT as well as the newer neuro-modulation therapies as abusive therapies obviates the fact that respondent has no clue as to the extent of the unique patient population suffering and searching for decades to obtain some relief from their MDD.
But when these least invasive treatment options fail to yield efficacy and the patient continues to suffer both in pain and anguish or escalates into suicidal ideations should one cease in one’s efforts to obtain some degree of wellness because the respondent considers a particular therapy to be abusive?
As long as the patient is reasonably educated and informed to make un-coerced medical decisions in collaboration with a trusted, caring, knowledgeable and licensed health care provider I consider the illness abusive along with the inability to obtain as well as the lack and availability of alternative treatment options as opposed to any therapy.
Warmly,
Herb
VNSdepression.com
I take great offense at people who refer to this practice as abuse. Obviously earlier attempts using electrodes to alter behavior brough on questions about mind control and so forth. The fact of the matter though is that individual personality comes from the makeup of the circuits in our Brain. Some of this is genetics, some of it environment. Those with a misfunctioning left ventral prefrontal circuit can find themselves mired in depression and hopelessness forever. Those with more active circuits can be have very outgoing, happy, extroverted lives. I happen to believe that left-handers and ambidextrous folks are more at risk for depression and substance abuse and one day hope to have a study with a large enough sample size to demonstrate this.
Those of us with treatment resistant depression would do ANYTHING to get our lives back. We must face a gamut of red-tape and ignorance from those in the medical profession who do not keep up with the latest research. We’re fed SSRIs and antipsychotics and told to “just deal with it”. CBT can be helpful for coping but it somecases its like asking someone with bipolar or schizophrenia to simple wish it away. I wish they would expand these trials to more folks willing to give it a try.