Paul B Fitzgerald1, Rebecca Segrave2, Karyn E Richardson3, Laura A Knox3, Sally Herring4, Zafiris J Daskalakis5, Richard G Bittar6. 1. Epworth Healthcare, The Epworth Clinic, Camberwell, Victoria, 3004, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia. Electronic address: paul.fitzgerald@monash.edu. 2. Brain and Mental Health Lab, School of Psychological Sciences, Monash University, Clayton, Melbourne, Victoria, Australia. 3. Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia. 4. Epworth Healthcare, The Epworth Clinic, Camberwell, Victoria, 3004, Australia. 5. Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada. 6. Precision Brain Spine and Pain Centre, Victoria, Australia; Deakin University, Victoria, Melbourne, Australia.
Abstract
BACKGROUND: Studies are increasingly investigating the therapeutic effects of deep brain stimulation (DBS) applied to a variety of brain regions in the treatment of patients with highly treatment refractory depression. Limited research to date has investigated the therapeutic potential of DBS applied to the Bed Nucleus Of Stria Terminalis (BNST). OBJECTIVE: The aim of this study was to explore the therapeutic potential of DBS applied to the BNST. METHOD: Five patients with highly treatment resistant depression underwent DBS to the BNST in an open label case series design. RESULTS: BNST DBS resulted in sustained remission of depression in two of the five patients, provided substantial therapeutic improvement two further patients, and had minimal antidepressant effect for the final patient. There were no operative complications and stimulation related side effects were limited and reversible with adjustment of stimulation. However, the time to achieve and complexity of programming required to achieve optimal therapeutic outcomes varied substantially between patients. CONCLUSION: DBS applied to the BNST as therapeutic potential in patients with highly refractory depression and warrants exploration in larger clinical studies.
BACKGROUND: Studies are increasingly investigating the therapeutic effects of deep brain stimulation (DBS) applied to a variety of brain regions in the treatment of patients with highly treatment refractory depression. Limited research to date has investigated the therapeutic potential of DBS applied to the Bed Nucleus Of Stria Terminalis (BNST). OBJECTIVE: The aim of this study was to explore the therapeutic potential of DBS applied to the BNST. METHOD: Five patients with highly treatment resistant depression underwent DBS to the BNST in an open label case series design. RESULTS: BNST DBS resulted in sustained remission of depression in two of the five patients, provided substantial therapeutic improvement two further patients, and had minimal antidepressant effect for the final patient. There were no operative complications and stimulation related side effects were limited and reversible with adjustment of stimulation. However, the time to achieve and complexity of programming required to achieve optimal therapeutic outcomes varied substantially between patients. CONCLUSION: DBS applied to the BNST as therapeutic potential in patients with highly refractory depression and warrants exploration in larger clinical studies.
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