TY  - JOUR
AU  - Bewernick, B.H.
AU  - Hurlemann, R.
AU  - Matusch, A.
AU  - Kayser, S.
AU  - Grubert, C.
AU  - Hadrysiewicz, B.
AU  - Axmacher, N.
AU  - Lemke, M.
AU  - Cooper-Mahkorn, D.
AU  - Cohen, M.X.
AU  - Brockmann, H.
AU  - Lenartz, D.
AU  - Sturm, V.
AU  - Schlaepfer, T.E.
TI  - Nucleus Accumbens Deep Brain Stimulation Decreases Ratings of Depression and Anxiety in Treatment-Resistant Depression
JO  - Biological psychiatry
VL  - 67
SN  - 0006-3223
CY  - Amsterdam [u.a.]
PB  - Elsevier Science
M1  - PreJuSER-8507
SP  - 110 - 116
PY  - 2010
N1  - This investigation-initiated study was funded in part (deep brain stimulation device, battery exchange, medical costs, limited support for study nurse) by a Grant of Medtronic, Inc. to Drs Schlaepfer and Strum. Dr. Hurlemann is supported by a Starting Independent Researcher Grant provided by the Ministry of Innovation, Science, Research and Technology of the State of North Rhine-Westphalia (MIWFT).
AB  - While most patients with depression respond to combinations of pharmacotherapy, psychotherapy, and electroconvulsive therapy (ECT), there are patients requiring other treatments. 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.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).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.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.
KW  - Adult
KW  - Aged
KW  - Amygdala: radionuclide imaging
KW  - Brain Mapping
KW  - Deep Brain Stimulation: methods
KW  - Depression: pathology
KW  - Depression: physiopathology
KW  - Depression: radionuclide imaging
KW  - Depression: therapy
KW  - Female
KW  - Fluorodeoxyglucose F18: diagnostic use
KW  - Gyrus Cinguli: radionuclide imaging
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Neuropsychological Tests
KW  - Nucleus Accumbens: physiology
KW  - Nucleus Accumbens: radionuclide imaging
KW  - Positron-Emission Tomography: methods
KW  - Prefrontal Cortex: physiopathology
KW  - Prefrontal Cortex: radionuclide imaging
KW  - Psychiatric Status Rating Scales
KW  - Treatment Outcome
KW  - Fluorodeoxyglucose F18 (NLM Chemicals)
KW  - J (WoSType)
LB  - PUB:(DE-HGF)16
C6  - pmid:19914605
UR  - <Go to ISI:>//WOS:000273201800004
DO  - DOI:10.1016/j.biopsych.2009.09.013
UR  - https://juser.fz-juelich.de/record/8507
ER  -