Characterizing the therapeutic response to deep brain stimulation for treatment-resistant depression: a single center long-term perspective

Abstract

The number of depressed patients treated with deep brain stimulation (DBS) is relatively small. However, experience with this intervention now spans more than 10 years at some centers, with study subjects typically monitored closely. Here we describe one center’s evolving impressions regarding optimal patient selection for DBS of the subcallosal cingulate (SCC) as well as observations of short- and long-term patterns in antidepressant response and mood reactivity. A consistent time course of therapeutic response with distinct behavioral phases is observed. Early phases are characterized by changes in mood reactivity and a transient and predictable worsening in self ratings prior to stabilization of response. It is hypothesized that this characteristic recovery curve reflects the timeline of neuroplasticity in response to DBS. Further investigation of these emerging predictable psychiatric, biological, and psychosocial patterns will both improve treatment optimization and enhance understanding and recognition of meaningful DBS antidepressant effects.

Quantifying the axonal pathways directly stimulated in therapeutic subcallosal cingulate deep brain stimulation

“…To date, 34 patients have been implanted in three cohorts at Emory University: (a) 17 in Holtzheimer et al (), (b) 11 in Riva‐Posse et al (), and (c) the 6 patients in this study. Patient selection has remained relatively constant across all the cohorts (Crowell et al, ), with Cohorts 2 and 3 being the most homogeneous, clinically. In terms of targeting, the therapeutic contacts in Cohorts 2 and 3 were selected using a connectomic blueprint (Riva‐Posse et al, ) and intraoperative behavioral responses (Choi et al, ).…”

Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

“…Close clinical monitoring and systematic long-term follow-up using small experimental cohorts outside of industry-sponsored trials have further provided new perspectives on the time course, trajectory and sustainability of DBS-mediated effects (Crowell et al, 2015). Notably, patients often experience contact-specific changes in mood, attention, psychomotor speed, and autonomic reactivity with initial testing during electrode implantation surgery.…”

Deep brain stimulation for treatment-resistant depression: Predicting response and optimizing treatment

“…On the other hand, a history of treatment responsiveness with return to inter-episode euthymia appears to be associated with response to DBS in TRD, at least as observed at Emory, the center with the most experience in SCC DBS [22]. In one cohort treated at Emory [7], duration of longest euthymic episode since the first onset of major depression was positively associated with response to SCC DBS following six months of open-label stimulation (unpublished data).…”