Response and Safety Outcomes in Treatment-Resistant Depression After Subcallosal Cingulate Gyrus Deep Brain Stimulation: Long-term Follow-up Study

Carlo Alemany, MD; Dolors Puigdemont, MD, PhD; Ana Martín-Blanco, MD, PhD; Rodrigo Rodríguez-Rodríguez, MD, PhD; Juan A. Aibar-Durán, MD; Muriel Vicent-Gil, PhD; Enric Álvarez, MD, PhD; Víctor Pérez, MD, PhD; Maria J. Portella, PhD; Javier de Diego-Adeliño, MD, PhD

J Clin Psychiatry 2023;84(4):22m14622

ABSTRACT

Objective: To replicate previous findings and to investigate related clinical factors of long-term benefits and safety of subcallosal cingulate gyrus deep brain stimulation (SCG-DBS) for treatment-resistant depression (TRD).

Methods: Sixteen patients with TRD (with either major depressive disorder or bipolar disorder, DSM-IV and DSM-5 criteria) receiving chronic SCG-DBS were followed for up to 11 years (January 2008 to June 2019). Demographic, clinical, and functioning data were collected pre-surgery and during the follow-up. Response was defined as a ≥ 50% decrease from baseline in the 17-item Hamilton Depression Rating Scale (HAM-D₁₇) score, and remission was defined as ≤ 7 in the HAM-D₁₇ score. The Illness Density Index (IDI) was used as a longitudinal measure of treatment effects. Survival analyses were performed for response outcomes and relapses.

Results: Depressive symptoms were significantly decreased over time (F = 2.37; P = .04). Response and remission rates were 75% and 62.5% at individual endpoint. Based on Kaplan-Meier curve analysis, 55% of patients reached remission in 139 days. IDI curves showed sustained clinical improvements as measured with HAM-D₁₇ and Clinical Global Impression and sustained functioning improvement as measured with Global Assessment of Functioning scores. The procedure was generally safe and well tolerated (122 adverse events across 81 patient-years, of which 25 were related to SCG-DBS). Two patients committed suicide long after surgery.

Conclusions: SCG-DBS produced a robust and protracted improvement in most patients, which reinforces the possibility that SCG-DBS could be an alternative for patients with treatment-resistant unipolar or bipolar depression. Identification of clinical and neurobiological response predictors should guide the continuation of DBS for TRD, to obtain its indication soon.

J Clin Psychiatry 2023;84(4):22m14622

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