Juan F Gálvez1, Zafer Keser2, Benson Mwangi3, Amna A Ghouse4, Albert J Fenoy5, Paul E Schulz6, Marsal Sanches7, Joao Quevedo8, Sudhakar Selvaraj9, Prashant Gajwani10, Giovana Zunta-Soares11, Khader M Hasan12, Jair C Soares13. 1. UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia. Electronic address: Juan.F.GalvezFlorez@uth.tmc.edu. 2. Department of Physical Medicine and Rehabilitation, TIRR Memorial Hermann Neuro-Recovery Research Center, Houston, TX, USA. Electronic address: Zafer.Keser@uth.tmc.edu. 3. UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: Benson.Irungu@uth.tmc.edu. 4. The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Amna.a.ghouse@uth.tmc.edu. 5. The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Albert.J.Fenoy@uth.tmc.edu. 6. The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Paul.E.Schulz@uth.tmc.edu. 7. UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, USA. Electronic address: Marsal.sanches@uth.tmc.edu. 8. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Joao.L.DeQuevedo@uth.tmc.edu. 9. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Sudhakar.Selvaraj@uth.tmc.edu. 10. The University of Texas Health Science Center at Houston, TX, USA. Electronic address: prashant.gajwani@uth.tmc.edu. 11. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Giovana.b.zuntasoares@uth.tmc.edu. 12. Department of Diagnostic and Interventional Imaging, Magnetic Resonance Imaging Research Division, Diffusion Tensor Imaging Lab, University of Texas Health Science Center at Houston, Houston, TX, USA. Electronic address: Khader.M.Hasan@uth.tmc.edu. 13. The University of Texas Health Science Center at Houston, TX, USA. Electronic address: Jair.C.Soares@uth.tmc.edu.
Abstract
INTRODUCTION: Despite a wide variety of therapeutic interventions for major depressive disorder (MDD), treatment resistant depression (TRD) remains to be prevalent and troublesome in clinical practice. In recent years, deep brain stimulation (DBS) has emerged as an alternative for individuals suffering from TRD not responding to combining antidepressants, multiple adjunctive strategies and electroconvulsive therapy (ECT). Although the best site for TRD-DBS is still unclear, pilot data suggests that the medial forebrain bundle (MFB) might be a key target to accomplish therapeutic efficacy in TRD patients. OBJECTIVE: To explore the anatomic, electrophysiologic, neurocognitive and treatment data supporting the MFB as a target for TRD-DBS. RESULTS: The MFB connects multiple targets involved in motivated behavior, mood regulation and antidepressant response. Specific phenomenology associated with TRD can be linked specifically to the superolateral branch (sl) of the MFB (slMFB). TRD patients who received DBS-slMFB reported high response/remission rates with an improvement in functioning and no significant adverse outcomes in their physical health or neurocognitive performance. DISCUSSION: The slMFB is an essential component of a network of structural and functional pathways connecting different areas possibly involved in the pathogenesis of mood disorders. Therefore, the slMFB should be considered as an exciting therapeutic target for DBS therapy to achieve a sustained relief in TRD patients. CONCLUSION: There is an urgent need for clinical trials exploring DBS-slMFB in TRD. Further efforts should pursue measuring baseline pro-inflammatory cytokines, oxidative stress, and cognition as possible biomarkers of DBS-slMFB response in order to aid clinicians in better patient selection.
INTRODUCTION: Despite a wide variety of therapeutic interventions for major depressive disorder (MDD), treatment resistant depression (TRD) remains to be prevalent and troublesome in clinical practice. In recent years, deep brain stimulation (DBS) has emerged as an alternative for individuals suffering from TRD not responding to combining antidepressants, multiple adjunctive strategies and electroconvulsive therapy (ECT). Although the best site for TRD-DBS is still unclear, pilot data suggests that the medial forebrain bundle (MFB) might be a key target to accomplish therapeutic efficacy in TRD patients. OBJECTIVE: To explore the anatomic, electrophysiologic, neurocognitive and treatment data supporting the MFB as a target for TRD-DBS. RESULTS: The MFB connects multiple targets involved in motivated behavior, mood regulation and antidepressant response. Specific phenomenology associated with TRD can be linked specifically to the superolateral branch (sl) of the MFB (slMFB). TRD patients who received DBS-slMFB reported high response/remission rates with an improvement in functioning and no significant adverse outcomes in their physical health or neurocognitive performance. DISCUSSION: The slMFB is an essential component of a network of structural and functional pathways connecting different areas possibly involved in the pathogenesis of mood disorders. Therefore, the slMFB should be considered as an exciting therapeutic target for DBS therapy to achieve a sustained relief in TRD patients. CONCLUSION: There is an urgent need for clinical trials exploring DBS-slMFB in TRD. Further efforts should pursue measuring baseline pro-inflammatory cytokines, oxidative stress, and cognition as possible biomarkers of DBS-slMFB response in order to aid clinicians in better patient selection.
Authors: James K Trevathan; Ali Yousefi; Hyung Ook Park; John J Bartoletta; Kip A Ludwig; Kendall H Lee; J Luis Lujan Journal: ACS Chem Neurosci Date: 2017-02-06 Impact factor: 4.418
Authors: Albert J Fenoy; Paul E Schulz; Marsal Sanches; Sudhakar Selvaraj; Christina L Burrows; Bashar Asir; Christopher R Conner; Joao Quevedo; Jair C Soares Journal: Mol Psychiatry Date: 2022-03-14 Impact factor: 13.437
Authors: Albert J Fenoy; Paul E Schulz; Sudhakar Selvaraj; Christina L Burrows; Giovanna Zunta-Soares; Kathryn Durkin; Paolo Zanotti-Fregonara; Joao Quevedo; Jair C Soares Journal: Transl Psychiatry Date: 2018-06-04 Impact factor: 6.222