31,40,42 Of note,
most symptoms of depression improved, with insomnia, decreased energy, interest and psychomotor speed, disturbed social contact, apathy, anhedonia, poor concentration, and planning all showing improvement after 3, 6, and 12 months of follow-up. Subsequent open-label studies of SCC DBS in TRD have demonstrated remission rates ranging from 33% to 58% with chronic stimulation (12 to 36 months).43-47 A case report showed efficacy for SCC DBS in a patient who previously had Inhibitors,research,lifescience,medical a dorsal anterior cingulotomy (which was initially beneficial, but followed by a depressive relapse).48 In one study, blinded discontinuation was associated with a significant increase in depression that improved when stimulation was reinstated.44 Across these various studies, no adverse effects were seen with acute or chronic SCC DBS. No cognitive impairments were found with long-term stimulation, and improvements were noted49 (Moreines et al, unpublished data). In one study including seven patients with bipolar II Inhibitors,research,lifescience,medical disorder, none showed hypomania or mania with acute or chronic stimulation.44 Ventral capsule/ventral striatum and nucleus accumbens The ventral internal capsule/ventral striatum (VC/VS) was the first target for the treatment of OCD, based on previous lesional therapies. Interestingly, depression also improved in OCD patients treated with DBS Inhibitors,research,lifescience,medical in
this region.34,50 This observation led to an open-label Inhibitors,research,lifescience,medical pilot study of VC/VS DBS in TRD, which demonstrated a 53% response rate and 40% remission rate at last follow-up (between 6 and 51 months of stimulation).51 These encouraging preliminary data led to a pivotal, double-blind, randomized, sham-controlled trial of VC/VS DBS in 30 patients with TRD. Unfortunately, no statistically significant efficacy was seen for active vs sham (off) DBS after 4 months Inhibitors,research,lifescience,medical of chronic treatment. Response rates were 20% and 14.3% in the active and sham groups, respectively.52
In studies of VC/VS DBS for OCD and depression, a number of mood, anxiety, and other changes have been associated with acute stimulation (eg, panic attacks, euphoria, facial muscle activity). However, these changes could be eliminated with adjustment of stimulation parameters and did not appear to relate to long-term Thalidomide efficacy. The nucleus accumbens (NAc) comprises the majority of the ventral striatal aspect of the VC/VS DBS target. More focal DBS of the NAc for TRD was hypothesized to have potential efficacy based on its importance in reward-seeking behavior (recognizing the prominent role of anhedonia in the syndrome of depression).53,54 Idelalisib molecular weight Indeed, in initial testing, anhedonia was one of the first symptoms to improve during NAc stimulation in TRD.54,55 In 11 patients with TRD, 12 months of chronic, open-label NAc DBS resulted in a 45% response rate and 9% remission rate.