Deep brain stimulation in the treatment of depression

Blomstedt, Patric; Sjöberg, Rickard L.; Hansson, Maja; Bodlund, Owe; Hariz, Marwan

doi:10.1111/j.1600-0447.2010.01625.x

Cited by 44 publications

(30 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, case observations are a valuable means of generating hypotheses and collecting information. This is especially relevant with regard to as yet experimental therapeutic methods such as DBS for the treatment of affective disorders, for which there is still limited clinical experience [23] and currently only one follow-up study [22] .…”

Section: Discussionmentioning

confidence: 99%

“…The recent adoption of deep brain stimulation (DBS) for psychiatric disease such as obsessive-compulsive disorder, Tourette's syndrome or major depression has already shown efficacy in a well-chosen, highly treatmentresistant collective [21][22][23] . While clinical results for patients suffering from chronic MDD are promising, the currently still experimental nature of DBS calls for a comprehensive analysis of mechanisms alongside the evaluation of antidepressant efficacy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Course of Brain-Derived Neurotrophic Factor Serum Levels in a Patient Treated with Deep Brain Stimulation of the Lateral Habenula

Hoyer

Kranaster²,

Sartorius³

et al. 2012

Neuropsychobiology

View full text Add to dashboard Cite

Introduction: According to the neurotrophin hypothesis, a brain-derived neurotrophic factor (BDNF) decrease has been postulated as a pivotal pathomechanism in affective disorder, and the treatment-associated increase in peripheral BDNF has been linked to therapeutic efficacy of antidepressant drugs and electroconvulsive therapy. However, in deep brain stimulation (DBS), a still experimental antidepressant treatment approach, this issue has not yet been investigated. Methods: We examine the long-term course of serum BDNF levels in a 64-year-old woman who is being treated with DBS of the lateral habenula for severe major depressive disorder. Results: Our main findings are a significant increase in BDNF serum levels following DBS of the lateral habenula and an inverse U-shaped correlation of depression scores and BDNF levels. Discussion: The data indicate that DBS, like other effective antidepressant treatments, may contribute to an increase in peripheral BDNF levels, which are thought to reflect central nervous DBS-induced neuroplastic changes. Moreover, our observations underscore the complex nature of disease-associated BDNF alterations. Their identification as either state or trait marker remains controversial and requires larger-scale longitudinal studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Course of Brain-Derived Neurotrophic Factor Serum Levels in a Patient Treated with Deep Brain Stimulation of the Lateral Habenula

Hoyer

Kranaster²,

Sartorius³

et al. 2012

Neuropsychobiology

View full text Add to dashboard Cite

show abstract

“…that has become the standard of care for movement disorders (1)(2)(3) and is under investigation in major depression (4)(5)(6). In DBS, chronic high-frequency stimulation of specific sites reduces symptoms in medically intractable illness.…”

Section: Eep Brain Stimulation (Dbs) Is a Neurosurgical Techniquementioning

confidence: 99%

Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear

Rodríguez-Romaguera

Monte

Quirk

2012

Proc. Natl. Acad. Sci. U.S.A.

125

128

View full text Add to dashboard Cite

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) reduces symptoms of intractable obsessive-compulsive disorder (OCD), but the mechanism of action is unknown. OCD is characterized by avoidance behaviors that fail to extinguish, and DBS could act, in part, by facilitating extinction of fear. We investigated this possibility by using auditory fear conditioning in rats, for which the circuits of fear extinction are well characterized. We found that DBS of the VS (the VC/VS homolog in rats) during extinction training reduced fear expression and strengthened extinction memory. Facilitation of extinction was observed for a specific zone of dorsomedial VS, just above the anterior commissure; stimulation of more ventrolateral sites in VS impaired extinction. DBS effects could not be obtained with pharmacological inactivation of either dorsomedial VS or ventrolateral VS, suggesting an extrastriatal mechanism. Accordingly, DBS of dorsomedial VS (but not ventrolateral VS) increased expression of a plasticity marker in the prelimbic and infralimbic prefrontal cortices, the orbitofrontal cortex, the amygdala central nucleus (lateral division), and intercalated cells, areas known to learn and express extinction. Facilitation of fear extinction suggests that, in accord with clinical observations, DBS could augment the effectiveness of cognitive behavioral therapies for OCD.prefrontal cortex | anxiety disorders | posttraumatic stress disorder | phosphorylated extracellular signal-regulated kinase | accumbens D eep brain stimulation (DBS) is a neurosurgical technique that has become the standard of care for movement disorders (1-3) and is under investigation in major depression (4-6). In DBS, chronic high-frequency stimulation of specific sites reduces symptoms in medically intractable illness. DBS of the ventral capsule and the adjacent ventral striatum (VC/VS) has been used to treat refractory obsessive-compulsive disorder (OCD) in the European Union and the United States (7-10). Little is known about how DBS acts in OCD, emphasizing the need for translational animal studies. A prominent feature observed in most OCD patients is repetitive avoidance behaviors to perceived threats (11,12). The persistent avoidance in OCD suggests a deficit in circuits that regulate fear extinction (11). Given the strong parallels between fear circuits in rodents and humans (13), well-characterized rodent models of fear conditioning could shed light on DBS mechanisms in OCD and related illnesses that feature pathological anxiety.The DBS target for OCD is the VC/VS (14), which contains fiber bundles interconnecting cortical areas implicated in fear extinction, such as the ventromedial prefrontal cortex, the dorsal anterior cingulate cortex, and the orbitofrontal cortex (OFC), with subcortical areas implicated in conditioned fear, such as the amygdala (15). Previous studies in anesthetized rats (16,17) have shown that DBS of the VS modifies the excitability of the OFC as well as prelimbic (PL) and infralimbic (IL) prefron...

show abstract

“…Clinical trials have shown that DBS of the Acc may be an effective and safe treatment for refractory OCD and major depressive disorder and some case studies have shown positive effects of Acc DBS on alcohol and drug addiction and eating disorders [17,18,47,48,49,50,51,52]. …”

Section: Discussionmentioning

confidence: 99%

“…The Acc has recently become an important target for deep brain stimulation (DBS) in some of those disorders when refractory to best medical treatment [12,13,14,15,16,17,18]. DBS is a neurosurgical reversible technique that uses the chronic electrical stimulation of deep brain structures to block or modulate neuronal circuits.…”

Section: Introductionmentioning

confidence: 99%

The Nucleus Accumbens beyond the Anterior Commissure: Implications for Psychosurgery

Neto¹,

Mourato²,

Neto³

et al. 2014

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Introduction: The nucleus accumbens (Acc) is a basal forebrain structure integrated in the dopaminergic cerebral rewarding circuits and implicated in some neuropsychiatric disorders. It has become a target for deep brain stimulation for some of these disorders when refractory to medical treatment. However, it is controversial as to which target is the best and similar results have been achieved with the stimulation of neighboring structures such as the bed nucleus of the stria terminalis (BNST). Previous studies have established the stereotactic anatomy of the human Acc, but some difficulties remain concerning its precise posterior limit, which is assumed to be at the level of the anterior commissure (AC). It is our purpose to clarify the anatomy of this zone, given the importance of its exact identification in psychosurgery. Methods: A total of 16 Acc were collected by autopsy, fixed, dissected, embedded and cut in coronal 5-µm slices. The slices were stained with hematoxylin and eosin, marked with anti-D1 and anti-D2 antibodies and analyzed under a microscope. Results: The human Acc has the same cellular structure as the dorsal striatum, except in its posterior subcommissural part where voluminous neurons prevail, similar to and contiguous with the BNST. Conclusions: The Acc is longer than previously described, with a sub- and postcommissural extension behind the AC, continuous with the BNST.

show abstract

Deep brain stimulation in the treatment of depression

Abstract: DBS is a promising treatment for therapy-refractory MDD. The published experience is, however, limited, and the method is at present an experimental therapy.

Cited by 44 publications

References 68 publications

Long-Term Course of Brain-Derived Neurotrophic Factor Serum Levels in a Patient Treated with Deep Brain Stimulation of the Lateral Habenula

Long-Term Course of Brain-Derived Neurotrophic Factor Serum Levels in a Patient Treated with Deep Brain Stimulation of the Lateral Habenula

Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear

The Nucleus Accumbens beyond the Anterior Commissure: Implications for Psychosurgery

Contact Info

Product

Resources

About