Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate
Open accessAbstract
High-frequency deep brain stimulation (DBS) represents a major stake for treatment for treatment-resistant depression (TRD). We describe a preliminary trial of DBS of two potential brain targets in chronic TRD: the nucleus accumbens (Acb) and, in the event of failure, the caudate nucleus. Patients were followed for 6 months before surgery (M0). From M1 to M5, they underwent stimulation of the Acb target. PET scans allowed us to track metabolic modifications resulting from this stimulation. The caudate target of nonresponders was stimulated between M5 and M9. Patients then entered an extension phase, in which it was possible to adapt stimulation parameters and treatments. Six patients were included and four were operated on. At M5, none of the patients were either responders or remitters, but we did observe a decrease in Hamilton Depression Rating Scale (HDRS) scores. Three patients were switched to caudate stimulation, but no improvement was observed. During the extension phase, the Acb target was stimulated for all patients, three of whom exhibited a significant response. A decrease in glucose metabolism was observed after Acb stimulation, in the posterior cingulate gyrus, left frontal lobe, superior and medial gyrus, and bilateral cerebellum. An increase in metabolism was observed in the bilateral frontal lobe (superior gyrus), left frontal lobe (medial gyrus), and right limbic lobe (anterior cingulate gyrus). The results of this trial suggest that Acb is a more promising target than the caudate. NCT01569711.
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In the Milett et al 2014 open-label study of four patients with treatment-resistant depression, ventral capsule/ventral striatum deep brain stimulation yielded a 25.0% remission rate at 14 months, measured by HDRS.
“| | Milett et al | 2014 Open label | N = 4 | 14 | 75.0% | 25.0% | HDRS |”
From Deep brain stimulation for depression. (2022) · cites this paper as [60]
In the Milett et al 2014 open-label study of four patients with treatment-resistant depression, ventral capsule/ventral striatum deep brain stimulation yielded a 75.0% response rate at 14 months, measured by HDRS.
“| | Milett et al | 2014 Open label | N = 4 | 14 | 75.0% | 25.0% | HDRS |”
From Deep brain stimulation for depression. (2022) · cites this paper as [60]
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- Authors
- Millet, B., Jaafari, N., Polosan, M., Baup, N., Giordana, B., Haegelen, C., Chabardes, S., Fontaine, D., Devaux, B., Yelnik, J., Fossati, P., Aouizerate, B., Krebs, M. O., Robert, G., Jay, T., Cornu, P., Vérin, M., Drapier, S., Drapier, D., Sauleau, P., Peron, J., Jeune, F. L., Naudet, F., & Reymann, J. M.
- Affiliations
- Centre Hospitalier Guillaume Régnier (FR)
- Centre Hospitalier Universitaire de Grenoble (FR)
- Centre Hospitalier Sainte-Anne (FR)
- Centre Hospitalier Universitaire de Nice (FR)
- Hôpital Pontchaillou (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Centre Hospitalier Charles Perrens (FR)
- Inserm (FR)
- Centre Eugène Marquis (FR)
- ORCID
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 24
- Issue
- 8
- Pages
- 1229-1239
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W1985126645
- Cited by
- 77
- References
- 50
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 10 · 2019: 2 · 2018: 5 · 2017: 9 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 1
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- HAL (submittedVersion, other-oa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Funders
- Medtronic
- Fondation Pierre Deniker pour la Recherche et la Prévention en Santé Mentale
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- deep brain stimulation, treatment-resistant depression, nucleus accumbens, caudate nucleus, limbic system, glucose metabolism, positron emission tomography, anterior cingulate cortex, frontal lobe
- MeSH terms
- Adult, Biophysics, Caudate Nucleus, Cognition, Depression, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Nucleus Accumbens, Prospective Studies, Imaging, Three-Dimensional, Deep Brain Stimulation, Positron-Emission Tomography
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