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Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression

Published online by Cambridge University Press:  15 December 2016

L. Subramanian ,
T. Bracht ,
P. Jenkins ,
S. Choppin ,
D. E. J. Linden ,
G. Phillips  and
B. A. Simpson
L. Subramanian
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
T. Bracht
Affiliation:
Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
P. Jenkins
Affiliation:
Cyncoed Consulting Rooms, Cardiff, UK
S. Choppin
Affiliation:
Universite Pierre et Marie Curie, Paris, France
D. E. J. Linden*
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK Cardiff and Vale University Health Board, Cardiff, UK
G. Phillips
Affiliation:
Cardiff and Vale University Health Board, Cardiff, UK
B. A. Simpson
Affiliation:
Cardiff and Vale University Health Board, Cardiff, UK
*
*Address for correspondence: Professor D. E. J. Linden, MD, MRC Centre for Neuropsychiatric Genetics & Genomics; Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK. (Email: lindend@cf.ac.uk)
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Abstract

Background

The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).

Method

This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.

Results

Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.

Conclusions

With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.

Keywords

Anterior capsulotomydepressionmood disorderstereotactic neurosurgerytreatment resistance
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 6 , April 2017 , pp. 1097 - 1106
Copyright
Copyright © Cambridge University Press 2016 

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References

Bracht, T, Horn, H, Strik, W, Federspiel, A, Schnell, S, Hofle, O, Stegmayer, K, Wiest, R, Dierks, T, Muller, TJ, Walther, S (2014). White matter microstructure alterations of the medial forebrain bundle in melancholic depression. Journal of Affective Disorders 155, 186–193.Google Scholar
Carvalho, AF, Berk, M, Hyphantis, TN, McIntyre, RS (2014). The integrative management of treatment-resistant depression: a comprehensive review and perspectives. Psychotherapy and Psychosomatics 83, 70–88.CrossRefGoogle ScholarPubMed
Catani, M, Howard, RJ, Pajevic, S, Jones, DK (2002). Virtual in vivo interactive dissection of white matter fasciculi in the human brain. NeuroImage 17, 77–94.Google Scholar
Christmas, D, Eljamel, MS, Butler, S, Hazari, H, MacVicar, R, Steele, JD, Livingstone, A, Matthews, K (2011). Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression. Journal of Neurology, Neurosurgery and Psychiatry 82, 594–600.Google Scholar
Coenen, VA, Schlaepfer, TE, Maedler, B, Panksepp, J (2011). Cross-species affective functions of the medial forebrain bundle-implications for the treatment of affective pain and depression in humans. Neuroscience and Biobehavioural Reviews 35, 1971–1981.Google Scholar
Dalgleish, T, Yiend, J, Bramham, J, Teasdale, JD, Ogilvie, AD, Malhi, G, Howard, R (2004). Neuropsychological processing associated with recovery from depression after stereotactic subcaudate tractotomy. American Journal of Psychiatry 161, 1913–1916.Google Scholar
Delaloye, S, Holtzheimer, PE (2014). Deep brain stimulation in the treatment of depression. Dialogues in Clinical Neuroscience 16, 83–91.Google Scholar
Dougherty, DD, Rezai, AR, Carpenter, LL, Howland, RH, Bhati, MT, O'Reardon, JP, Eskandar, EN, Baltuch, GH, Machado, AD, Kondziolka, D, Cusin, C, Evans, KC, Price, LH, Jacobs, K, Pandya, M, Denko, T, Tyrka, AR, Brelje, T, Deckersbach, T, Kubu, C, Malone, DA (2015). A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biological Psychiatry 78, 240–248.Google Scholar
El-Hage, W, Leman, S, Camus, V, Belzung, C (2013). Mechanisms of antidepressant resistance. Frontiers in Pharmacology 4, 146, 1–23.CrossRefGoogle ScholarPubMed
Feliu, M, Edwards, CL, Sudhakar, S, McDougald, C, Raynor, R, Johnson, S, Byrd, G, Whitfield, K, Jonassaint, C, Romero, H, Edwards, L, Wellington, C, Hill, BK, Sollers, J, Logue, PE (2008). Neuropsychological effects and attitudes in patients following electroconvulsive therapy. Neuropsychiatric Disease and Treatment 4, 613–617.Google Scholar
Göktepe, EO, Young, LB, Bridges, PK (1975). A further review of the results of sterotactic subcaudate tractotomy. British Journal of Psychiatry 126, 270–280.CrossRefGoogle ScholarPubMed
Greenberg, BD, Rauch, SL, Haber, SN (2010). Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology Reviews 35, 317–336.CrossRefGoogle ScholarPubMed
Henderson, SE, Johnson, AR, Vallejo, AI, Katz, L, Wong, E, Gabbay, E (2013). A preliminary study of white matter in adolescent depression: relationships with illness severity, anhedonia, and irritability. Frontiers in Psychiatry 4, Article 152.Google Scholar
Herner, T (1961). Treatment of mental disorders with frontal stereotaxic thermo-lesions. A follow-up of 116 cases. Acta Psychiatrica Scandinavica 36 (Suppl. 158), 1–140.Google Scholar
Hodgkiss, AD, Malizia, AL, Bartlett, JR, Bridges, PK (1995). Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979–1991. Journal of Neuropsychiatry and Clinical Neurosciences 7, 230–234.Google ScholarPubMed
Hurwitz, TA, Honey, CR, Allen, J, Gosselin, C, Hewko, R, Martzke, J, Bogod, N, Taylor, P (2012). Bilateral anterior capsulotomy for intractable depression. Journal of Neuropsychiatry and Clinical Neurosciences 24, 176–182.Google Scholar
Kocabicak, E, Temel, Y, Hollig, A, Falkenburger, B, Tan, SKH (2015). Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders. Neuropsychiatric Disease and Treatment 11, 1051–1066.Google ScholarPubMed
Mayberg, HS, Lozano, AM, Voon, V, McNeely, HE, Seminowicz, D, Hamani, C, Schwalb, JM, Kennedy, SH (2005). Deep brain stimulation for treatment-resistant depression. Neuron 45, 651–660.Google Scholar
Nuttin, B, Wu, H, Mayberg, H, Hariz, M, Gabriels, L, Galert, T, Merkel, R, Kubu, C, Vilela-Filho, O, Matthews, K, Taira, T, Lozano, AM, Schechtmann, G, Doshi, P, Broggi, G, Regis, J, Alkhani, A, Sun, B, Eljamel, S, Schulder, M, Kaplitt, M, Eskandar, E, Rezai, A, Krauss, JK, Hilven, P, Schuurman, R, Ruiz, P, Chang, JW, Cosyns, P, Lipsman, N, Voges, J, Cosgrove, R, Li, Y, Schlaepfer, T (2014). Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. Journal of Neurology, Neurosurgery and Psychiatry 0, 1–6.Google Scholar
Pouratian, N, Reames, DL, Frysinger, R, Elias, WJ (2011). Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery. Journal of Neurosurgery 115, 310–315.Google Scholar
Rakofsky, JJ, Holtzheimer, PE, Nemeroff, CB (2009). Emerging targets for antidepressant therapies. Current Opinion in Chemical Biology 13, 291–302.Google Scholar
Rauch, SL (1995). Psychosurgery. Neurosurgery Clinics of North America 6, 167–176.Google Scholar
Sachdev, PS, Sachdev, J (2005). Long-term outcome of neurosurgery for the treatment of resistant depression. Journal of Neuropsychiatry and Clinical Neurosciences 17, 478–485.Google Scholar
Schlaepfer, TE, Bewernick, BH, Kayser, S, Madler, B, Coenen, VA (2013). Rapid effects of deep brain stimulation for treatment-resistant major depression. Biological Psychiatry 73, 1204–1212.Google Scholar
Schlaepfer, TE, Bewernick, BH, Kayser, S, Hurlemann, R, Coenen, VA (2014). Deep brain stimulation of the human reward system for major depression-rationale, outcomes and outlook. Neuropsychopharmacology 39, 1303–1314.CrossRefGoogle ScholarPubMed
Schoene-Bake, JC, Parpaley, Y, Weber, B, Panksepp, J, Hurwitz, TA, Coenen, VA (2010). Tractographic analysis of historical lesion surgery for depression. Neuropsychopharmacology 35, 2553–2563.Google Scholar
Shields, DC, Asaad, W, Eskandar, EN, Jain, FA, Cosgrove, GR, Flaherty, AW, Cassem, EH, Price, BH, Rauch, SL, Dougherty, DD (2008). Prospective assessment of stereotactic ablative surgery for intractable major depression. Biological Psychiatry 64, 449–454.Google Scholar
Steele, JD, Christmas, D, Eljamel, MS, Matthews, K (2008). Anterior cingulotomy for major depression: clinical outcome and relationship to lesion characteristics. Biological Psychiatry 63, 670–677.Google Scholar
UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361, 799–808.Google Scholar