Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis

Pauline Sarah Münchenberg, Eileen M. Joyce, Keith Matthews, David Christmas, Ludvic Zrinzo (Lead / Corresponding author)

    Research output: Contribution to journalReview articlepeer-review

    5 Citations (Scopus)
    82 Downloads (Pure)

    Abstract

    (1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery-Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25-2.07). Anterior cingulotomy (two studies, n = 22) and anterior capsulotomy (three studies, n = 42) showed similar effect sizes: 1.51 (CI 0.82-2.20) vs. 1.74 (CI 1.23-2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% (n = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure (n = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD.

    Original languageEnglish
    Article number1379
    Number of pages15
    JournalBrain sciences
    Volume12
    Issue number10
    DOIs
    Publication statusPublished - 12 Oct 2022

    Keywords

    • anterior capsulotomy
    • anterior cingulotomy
    • major depressive disorder
    • stereotactic radiofrequency ablation
    • treatment-refractory depression

    ASJC Scopus subject areas

    • General Neuroscience

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