Long-Term Outcome of Neurosurgery for the Treatment of Resistant Depression
Neuropsychiatric Institute, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia. Journal of Neuropsychiatry
(Impact Factor: 2.82).
02/2005; 17(4):478-85. DOI: 10.1176/appi.neuropsych.17.4.478
Between 1973 and 1995, a total of 76 patients were treated with bilateral stereotactic, orbitomedial lesions for resistant severe depression at the Neuropsychiatric Institute, Sydney, Australia. On follow up after a mean 14.4 years, 24 (31.6%) subjects were confirmed dead, with six having committed suicide. Of the 52 patients still alive (mean age 62.9 years), 23 were interviewed in detail, and lesions verified in 18 with magnetic resonance imaging (MRI). On a 6-point global outcome rating scale, rated by consensus between two independent psychiatrists, five (22.7%) were judged to be completely recovered and another 11 (50%) showed significant improvement. The improvement was noted within days or weeks of the surgery. Adverse effects were epilepsy (2 subjects), marked personality change (1), weight gain (2), and mild personality change (5). Any reported cognitive impairment was mild. No definite predictors of improvement were identified.
Available from: Pablo Andrade
- "Of the first 40 operated patients, five of whom with depression, four showed mild to large improvement of depressive symptoms [55, 56]. Three other studies showed an improvement percentage of 30–78% [57, 79, 97]. The most common reported side effects were drowsiness, weight gain, and memory problems, but also, epilepsy, urine incontinence, and personality changes were described [55–57, 79, 97]. "
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Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5–10% of the general population and up to 20–25% for the lifetime period.
Nowadays, conventional treatment includes psychotherapy and pharmacotherapy; however, more than 60% of the treated patients respond unsatisfactorily, and almost one fifth becomes refractory to these therapies at long-term follow-up.
Growing social incapacity and economic burdens make the medical community strive for better therapies, with fewer complications. Various nonpharmacological techniques like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, lesion surgery, and deep brain stimulation have been developed for this purpose.
We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods.
Available from: Wael F Asaad
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ABSTRACT: Despite therapeutic advances for major depression, a subset of patients with this disorder does not respond to conventional treatment. Stereotactic ablative procedures such as anterior cingulotomy have been performed in severely affected, treatment-resistant patients, but the long-term results of such procedures are not fully understood.
Findings are reported for 33 patients with severe treatment-resistant major depression who underwent ablative stereotactic procedures (dorsal anterior cingulotomy followed if necessary by subcaudate tractotomy). Preoperative and long-term postoperative Beck Depression Inventory scores were obtained along with postoperative Clinical Global Improvement values. Both were analyzed to evaluate patients' responses to the surgical procedure(s).
At mean follow-up of 30 months after one or more stereotactic ablative procedures, 11 patients (33.3%) were classified as responders, 14 (42.4%) were partial responders, and 8 (24.2%) did not respond to the surgical procedure(s). Among those (17) who underwent only one procedure, seven (41.2%) responded, whereas six (35.3%) and four (23.5%) showed partial or no response, respectively. Among patients who required multiple surgical procedures, four patients (25%) responded, whereas eight (50%) and four (25%) patients demonstrated partial or no responses, respectively, at long-term follow-up evaluations.
Approximately 75% of depression patients previously resistant to antidepressant therapies received partial or substantial benefit from stereotactic ablative procedures. Those requiring only a single anterior cingulotomy tended to demonstrate more pronounced responses than patients who underwent multiple surgical procedures.
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