Skip to main content Accessibility help
×
Home

Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression

  • L. Subramanian (a1) (a2), T. Bracht (a2), P. Jenkins (a3), S. Choppin (a4), D. E. J. Linden (a1) (a2) (a5), G. Phillips (a5) and B. A. Simpson (a5)...

Abstract

Background

The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).

Method

This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.

Results

Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.

Conclusions

With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.

Copyright

Corresponding author

*Address for correspondence: Professor D. E. J. Linden, MD, MRC Centre for Neuropsychiatric Genetics & Genomics; Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK. (Email: lindend@cf.ac.uk)

References

Hide All
Bracht, T, Horn, H, Strik, W, Federspiel, A, Schnell, S, Hofle, O, Stegmayer, K, Wiest, R, Dierks, T, Muller, TJ, Walther, S (2014). White matter microstructure alterations of the medial forebrain bundle in melancholic depression. Journal of Affective Disorders 155, 186193.
Carvalho, AF, Berk, M, Hyphantis, TN, McIntyre, RS (2014). The integrative management of treatment-resistant depression: a comprehensive review and perspectives. Psychotherapy and Psychosomatics 83, 7088.
Catani, M, Howard, RJ, Pajevic, S, Jones, DK (2002). Virtual in vivo interactive dissection of white matter fasciculi in the human brain. NeuroImage 17, 7794.
Christmas, D, Eljamel, MS, Butler, S, Hazari, H, MacVicar, R, Steele, JD, Livingstone, A, Matthews, K (2011). Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression. Journal of Neurology, Neurosurgery and Psychiatry 82, 594600.
Coenen, VA, Schlaepfer, TE, Maedler, B, Panksepp, J (2011). Cross-species affective functions of the medial forebrain bundle-implications for the treatment of affective pain and depression in humans. Neuroscience and Biobehavioural Reviews 35, 19711981.
Dalgleish, T, Yiend, J, Bramham, J, Teasdale, JD, Ogilvie, AD, Malhi, G, Howard, R (2004). Neuropsychological processing associated with recovery from depression after stereotactic subcaudate tractotomy. American Journal of Psychiatry 161, 19131916.
Delaloye, S, Holtzheimer, PE (2014). Deep brain stimulation in the treatment of depression. Dialogues in Clinical Neuroscience 16, 8391.
Dougherty, DD, Rezai, AR, Carpenter, LL, Howland, RH, Bhati, MT, O'Reardon, JP, Eskandar, EN, Baltuch, GH, Machado, AD, Kondziolka, D, Cusin, C, Evans, KC, Price, LH, Jacobs, K, Pandya, M, Denko, T, Tyrka, AR, Brelje, T, Deckersbach, T, Kubu, C, Malone, DA (2015). A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biological Psychiatry 78, 240248.
El-Hage, W, Leman, S, Camus, V, Belzung, C (2013). Mechanisms of antidepressant resistance. Frontiers in Pharmacology 4, 146, 123.
Feliu, M, Edwards, CL, Sudhakar, S, McDougald, C, Raynor, R, Johnson, S, Byrd, G, Whitfield, K, Jonassaint, C, Romero, H, Edwards, L, Wellington, C, Hill, BK, Sollers, J, Logue, PE (2008). Neuropsychological effects and attitudes in patients following electroconvulsive therapy. Neuropsychiatric Disease and Treatment 4, 613617.
Göktepe, EO, Young, LB, Bridges, PK (1975). A further review of the results of sterotactic subcaudate tractotomy. British Journal of Psychiatry 126, 270280.
Greenberg, BD, Rauch, SL, Haber, SN (2010). Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology Reviews 35, 317336.
Henderson, SE, Johnson, AR, Vallejo, AI, Katz, L, Wong, E, Gabbay, E (2013). A preliminary study of white matter in adolescent depression: relationships with illness severity, anhedonia, and irritability. Frontiers in Psychiatry 4, Article 152.
Herner, T (1961). Treatment of mental disorders with frontal stereotaxic thermo-lesions. A follow-up of 116 cases. Acta Psychiatrica Scandinavica 36 (Suppl. 158), 1140.
Hodgkiss, AD, Malizia, AL, Bartlett, JR, Bridges, PK (1995). Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979–1991. Journal of Neuropsychiatry and Clinical Neurosciences 7, 230234.
Hurwitz, TA, Honey, CR, Allen, J, Gosselin, C, Hewko, R, Martzke, J, Bogod, N, Taylor, P (2012). Bilateral anterior capsulotomy for intractable depression. Journal of Neuropsychiatry and Clinical Neurosciences 24, 176182.
Kocabicak, E, Temel, Y, Hollig, A, Falkenburger, B, Tan, SKH (2015). Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders. Neuropsychiatric Disease and Treatment 11, 10511066.
Mayberg, HS, Lozano, AM, Voon, V, McNeely, HE, Seminowicz, D, Hamani, C, Schwalb, JM, Kennedy, SH (2005). Deep brain stimulation for treatment-resistant depression. Neuron 45, 651660.
Nuttin, B, Wu, H, Mayberg, H, Hariz, M, Gabriels, L, Galert, T, Merkel, R, Kubu, C, Vilela-Filho, O, Matthews, K, Taira, T, Lozano, AM, Schechtmann, G, Doshi, P, Broggi, G, Regis, J, Alkhani, A, Sun, B, Eljamel, S, Schulder, M, Kaplitt, M, Eskandar, E, Rezai, A, Krauss, JK, Hilven, P, Schuurman, R, Ruiz, P, Chang, JW, Cosyns, P, Lipsman, N, Voges, J, Cosgrove, R, Li, Y, Schlaepfer, T (2014). Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. Journal of Neurology, Neurosurgery and Psychiatry 0, 16.
Pouratian, N, Reames, DL, Frysinger, R, Elias, WJ (2011). Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery. Journal of Neurosurgery 115, 310315.
Rakofsky, JJ, Holtzheimer, PE, Nemeroff, CB (2009). Emerging targets for antidepressant therapies. Current Opinion in Chemical Biology 13, 291302.
Rauch, SL (1995). Psychosurgery. Neurosurgery Clinics of North America 6, 167176.
Sachdev, PS, Sachdev, J (2005). Long-term outcome of neurosurgery for the treatment of resistant depression. Journal of Neuropsychiatry and Clinical Neurosciences 17, 478485.
Schlaepfer, TE, Bewernick, BH, Kayser, S, Madler, B, Coenen, VA (2013). Rapid effects of deep brain stimulation for treatment-resistant major depression. Biological Psychiatry 73, 12041212.
Schlaepfer, TE, Bewernick, BH, Kayser, S, Hurlemann, R, Coenen, VA (2014). Deep brain stimulation of the human reward system for major depression-rationale, outcomes and outlook. Neuropsychopharmacology 39, 13031314.
Schoene-Bake, JC, Parpaley, Y, Weber, B, Panksepp, J, Hurwitz, TA, Coenen, VA (2010). Tractographic analysis of historical lesion surgery for depression. Neuropsychopharmacology 35, 25532563.
Shields, DC, Asaad, W, Eskandar, EN, Jain, FA, Cosgrove, GR, Flaherty, AW, Cassem, EH, Price, BH, Rauch, SL, Dougherty, DD (2008). Prospective assessment of stereotactic ablative surgery for intractable major depression. Biological Psychiatry 64, 449454.
Steele, JD, Christmas, D, Eljamel, MS, Matthews, K (2008). Anterior cingulotomy for major depression: clinical outcome and relationship to lesion characteristics. Biological Psychiatry 63, 670677.
UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361, 799808.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed