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@ARTICLE{Bewernick:8507,
      author       = {Bewernick, B.H. and Hurlemann, R. and Matusch, A. and
                      Kayser, S. and Grubert, C. and Hadrysiewicz, B. and
                      Axmacher, N. and Lemke, M. and Cooper-Mahkorn, D. and Cohen,
                      M.X. and Brockmann, H. and Lenartz, D. and Sturm, V. and
                      Schlaepfer, T.E.},
      title        = {{N}ucleus {A}ccumbens {D}eep {B}rain {S}timulation
                      {D}ecreases {R}atings of {D}epression and {A}nxiety in
                      {T}reatment-{R}esistant {D}epression},
      journal      = {Biological psychiatry},
      volume       = {67},
      issn         = {0006-3223},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {PreJuSER-8507},
      pages        = {110 - 116},
      year         = {2010},
      note         = {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).},
      abstract     = {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.},
      keywords     = {Adult / Aged / Amygdala: radionuclide imaging / Brain
                      Mapping / Deep Brain Stimulation: methods / Depression:
                      pathology / Depression: physiopathology / Depression:
                      radionuclide imaging / Depression: therapy / Female /
                      Fluorodeoxyglucose F18: diagnostic use / Gyrus Cinguli:
                      radionuclide imaging / Humans / Male / Middle Aged /
                      Neuropsychological Tests / Nucleus Accumbens: physiology /
                      Nucleus Accumbens: radionuclide imaging / Positron-Emission
                      Tomography: methods / Prefrontal Cortex: physiopathology /
                      Prefrontal Cortex: radionuclide imaging / Psychiatric Status
                      Rating Scales / Treatment Outcome / Fluorodeoxyglucose F18
                      (NLM Chemicals) / J (WoSType)},
      cin          = {INM-2},
      ddc          = {570},
      cid          = {I:(DE-Juel1)INM-2-20090406},
      pnm          = {Funktion und Dysfunktion des Nervensystems (FUEK409) /
                      89571 - Connectivity and Activity (POF2-89571)},
      pid          = {G:(DE-Juel1)FUEK409 / G:(DE-HGF)POF2-89571},
      shelfmark    = {Neurosciences / Psychiatry},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:19914605},
      UT           = {WOS:000273201800004},
      doi          = {10.1016/j.biopsych.2009.09.013},
      url          = {https://juser.fz-juelich.de/record/8507},
}