Można np. elektrowstrząsami szczególnie gdy przebeg jest ciężki.
Można też zastosować TMS lub VMS, ale nie jest to jeszcze popularne.
Co do BDS to raczej zapomnij, Berta zapewnie to miała na myśli
raczej należy to traktować jako ostanią deskę ratunku.
Biol Psychiatry. 2010 Jan 15;67(2):110-6.
Nucleus accumbens deep brain stimulation decreases ratings of
depression and anxiety in treatment-resistant depression.
Bewernick BH, Hurlemann R, Matusch A, Kayser S, Grubert C,
Hadrysiewicz B, Axmacher N, Lemke M, Cooper-Mahkorn D, Cohen MX,
Brockmann H, Lenartz D, Sturm V, Schlaepfer TE.
Department of Psychiatry and Psychotherapy, University Hospital,
53105 Bonn, Germany.
BACKGROUND: While most patients with depression respond to
combinations of pharmacotherapy, psychotherapy, and
electroconvulsive therapy (ECT), there are patients requiring other
Deep brain stimulation (DBS) allows modulation of
brain regions that are dysfunctional in depression. Since anhedonia
is a feature of depression and there is evidence of dysfunction of
the reward system, DBS to the nucleus accumbens (NAcc) might be
promising. METHODS: Ten patients suffering from very resistant forms
of depression (treatment-resistant depression [TRD]), not responding
to pharmacotherapy, psychotherapy, or ECT, were implanted with
bilateral DBS electrodes in the NAcc. The mean (+/-SD) length of the
current episode was 10.8 (+/-7.5) years; the number of past
treatment courses was 20.8 (+/-8.4); and the mean Hamilton
Depression Rating Scale (HDRS) was 32.5 (+/-5.3). RESULTS: Twelve
months following initiation of DBS treatment, five patients reached
50% reduction of the HDRS (responders, HDRS = 15.4 [+/-2.8]). The
number of hedonic activities increased significantly. Interestingly,
ratings of anxiety (Hamilton Anxiety Scale) were reduced in the
whole group but more pronounced in the responders. The [18F]-2-
fluoro-2-deoxy-D-glucose positron emission tomography data revealed
that NAcc-DBS decreased metabolism in the subgenual cingulate and in
prefrontal regions including orbital prefrontal cortex. A volume of
interest analysis comparing responders and nonresponders identified
metabolic decreases in the amygdala. CONCLUSIONS: We demonstrate
antidepressant and antianhedonic effects of DBS to NAcc in patients
suffering from TRD. In contrast to other DBS depression studies,
there was also an antianxiety effect. These effects are correlated
with localized metabolic changes.
Biol Psychiatry. 2008 Sep 15;64(6):461-7.
Subcallosal cingulate gyrus deep brain stimulation for treatment-
Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH.
Division of Neurosurgery, University of Toronto, Toronto, Canada.
BACKGROUND: A preliminary report in six patients suggested that deep
brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) may
provide benefit in treatment-resistant depression (TRD). We now
report the results of these and an additional 14 patients with
extended follow-up. METHODS: Twenty patients with TRD underwent
serial assessments before and after SCG DBS. We determined the
percentage of patients who achieved a response (50% or greater
reduction in the 17-item Hamilton Rating Scale for Depression [HRSD-
17]) or remission (scores of 7 or less) after surgery. We also
examined changes in brain metabolism associated with DBS, using
positron emission tomography. RESULTS: There were both early and
progressive benefits to DBS. One month after surgery, 35% of
patients met criteria for response with 10% of patients in
remission. Six months after surgery, 60% of patients were responders
and 35% met criteria for remission, benefits that were largely
maintained at 12 months. Deep brain stimulation therapy was
associated with specific changes in the metabolic activity localized
to cortical and limbic circuits implicated in the pathogenesis of
depression. The number of serious adverse effects was small with no
patient experiencing permanent deficits. CONCLUSIONS: This study
suggests that DBS is relatively safe and provides significant
improvement in patients with TRD. Subcallosal cingulate gyrus DBS
likely acts by modulating brain networks whose dysfunction leads to
depression. The procedure is well tolerated and benefits are
sustained for at least 1 year. A careful double-blind appraisal is
required before the procedure can be recommended for use on a wider
J Neurosurg. 2009 Dec;111(6):1209-15.
Deep brain stimulation of the subcallosal cingulate gyrus for
depression: anatomical location of active contacts in clinical
responders and a suggested guideline for targeting.
Hamani C, Mayberg H, Snyder B, Giacobbe P, Kennedy S, Lozano AM.
Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst
Street, WW 4-447 Toronto, Ontario M5T2S8 Canada.
OBJECT: Deep brain stimulation (DBS) of the subcallosal cingulate
gyrus (SCG), including Brodmann area 25, is currently being
investigated for the treatment of major depressive disorder (MDD).
As a potential emerging therapy, optimal target selection within the
SCG has still to be determined. The authors compared the location of
the electrode contacts in responders and nonresponders to DBS of the
SCG and correlated the results with clinical outcome to help in
identifying the optimal target within the region. Based on the
location of the active contacts used for long-term stimulation in
responders, the authors suggest a standardized method of targeting
the SCG in patients with MDD. METHODS: Postoperative MR imaging
studies of 20 patients with MDD treated with DBS of the SCG were
analyzed. The authors assessed the location of the active contacts
relative to the midcommissural point and in relation to anatomical
landmarks within the medial aspect of the frontal lobe. For this, a
grid with 2 main lines was designed, with 1 line in the anterior-
posterior and 1 line in the dorsal-ventral axis. Each of these lines
was divided into 100 units, and data were converted into
percentages. The anterior-posterior line extended from the anterior
commissure (AC) to the projection of the anterior aspect of the
corpus callosum (CCa). The dorsal-ventral line extended from the
inferior portion of the CC (CCi) to the most ventral aspect of the
frontal lobe (abbreviated "Fr" for the formula). RESULTS: Because
the surgical technique did not vary across patients, differences in
stereotactic coordinates between responders and nonresponders did
not exceed 1.5 mm in any axis (x, y, or z). In patients who
responded to the procedure, contacts used for long-term stimulation
were in close approximation within the SCG. In the anterior-
posterior line, these contacts were located within a 73.2 +/- 7.7
percentile distance from the AC (with the AC center being 0% and the
line crossing the CCa being 100%). In the dorsal-ventral line,
active contacts in responders were located within a 26.2 +/- 13.8
percentile distance from the CCi (with the CCi edge being 0% and the
Fr inferior limit being 100%). In the medial-lateral plane, most
electrode tips were in the transition between the gray and white
matter of SCG. CONCLUSIONS: Active contacts in patients who
responded to DBS were relatively clustered within the SCG. Because
of the anatomical variability in the size and shape of the SCG, the
authors developed a method to standardize the targeting of this