Neurosurgical Treatments for Patients with Chronic, Treatment-Refractory Depression: A Retrospective, Consecutive, Case Series Comparison of Anterior Capsulotomy, Anterior Cingulotomy and Vagus Nerve Stimulation

David Christmas (Lead / Corresponding author), Keith Matthews

Research output: Contribution to journalArticle

3 Citations (Scopus)
512 Downloads (Pure)

Abstract

Background: The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory depression (TRD) remains weak. There is limited comparative information available to guide the choice of intervention for patients with the most severe and disabling forms of illness.

Objectives: The aim of this work was to describe the 12-month clinical outcomes of patients with chronic TRD treated with anterior capsulotomy (ACAPS; n = 5), anterior cingulotomy (ACING; n = 5) or vagus nerve stimulation (VNS; n = 5).

Methods: We performed a retrospective, consecutive, case series comparison.

Results: With clinical response defined as a ≥50% reduction from the baseline MADRS score, response rates were 40% for ACAPS, 60% for ACING and 20% for VNS. Adverse effects from all three procedures were relatively mild, consistent with previous reports and, in most cases, transient. Adverse effects from VNS were related to active stimulation, and were modifiable and diminished in severity over time. There were no deaths.

Conclusions: Although based on a small sample, our data represent a unique comparison of ACAPS, ACING and VNS for chronic TRD. The three cohorts were broadly equivalent in terms of baseline clinical characteristics, indices of chronicity, illness severity and estimates of previous failed treatments. ACING and ACAPS, but not VNS, were associated with favourable response rates at 12 months.

Original languageEnglish
Pages (from-to)387-392
Number of pages6
JournalStereotactic and Functional Neurosurgery
Volume93
Issue number6
Early online date16 Dec 2015
DOIs
Publication statusPublished - Feb 2016

Keywords

  • Anterior capsulotomy
  • Anterior cingulotomy
  • Treatment-refractory depression#
  • Vagus nerve stimulation

Fingerprint Dive into the research topics of 'Neurosurgical Treatments for Patients with Chronic, Treatment-Refractory Depression: A Retrospective, Consecutive, Case Series Comparison of Anterior Capsulotomy, Anterior Cingulotomy and Vagus Nerve Stimulation'. Together they form a unique fingerprint.

  • Profiles

    No photo of Keith Matthews

    Matthews, Keith

    Person: Academic

    Cite this