The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.
Acute severe depression induced by intraoperative stimulation of the substantia nigra: A case report
Abstract
We present a 62 years old man with Parkinson's disease (PD) who underwent bilateral stimulation in the subthalamic nucleus (STN). During the intraoperative evaluation, stimulation through the lowest contact in the right STN area, induced an acute depressive state, during which the patient was crying and expressing that he did not want to live. The patient returned to his normal state of mood within seconds after the cessation of stimulation. Repeated blinded stimulations resulted in the same response. Immediate postoperative magnetic resonance imaging (MRI) revealed that the lowest contact of the right electrode was located in the substantia nigra.
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In deep brain stimulation of human beings, patients declare these subjective states in words.
“in DBS of human beings, they declare these subjective states in words (e.g., Blomstedt et al., 2007).”
From The Hard Problem of Consciousness and the Free Energy Principle (2019) · cites this paper as Blomstedt et al., 2007
Citations
Cites
Transient Acute Depression Induced by High-Frequency Deep-Brain Stimulation
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Compulsions, Parkinson's disease, and stimulation
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Mirthful laughter induced by subthalamic nucleus stimulation
Krack, P., Kumar, R., Ardouin, C., Limousin, P. D., McVicker, J. M., Benabid, A., & Pollak, P. (2001) · Movement Disorders · doi:10.1002/mds.1174 · Cited by 301
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The brain basis of emotion: a meta-analytic review
Lindquist, K. A., Wager, T. D., Kober, H., Bliss-Moreau, E., & Barrett, L. F. (2012) · Behavioral and Brain Sciences · doi:10.1017/s0140525x11000446 · Cited by 2,320
Depression in Parkinson disease—epidemiology, mechanisms and management
Aarsland, D., Påhlhagen, S., Ballard, C. G., Ehrt, U., & Svenningsson, P. (2011) · Nature Reviews Neurology · doi:10.1038/nrneurol.2011.189 · Cited by 626
Depression and Parkinson’s Disease: Current Knowledge
Marsh, L. (2013) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-013-0409-5 · Cited by 434
“Case reports describe acute depressive states on stimulation of the substantia nigra [42, 43].”
BackgroundMood and behavioural effects of subthalamic stimulation in Parkinson's disease.
Castrioto, A., Lhommée, E., Moro, E., & Krack, P. (2014) · Lancet Neurology · doi:10.1016/s1474-4422(13)70294-1 · Cited by 288
The Hard Problem of Consciousness and the Free Energy Principle
Solms, M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02714 · Cited by 239
Weiß, D., Walach, M. T., Meisner, C., Fritz, M., Scholten, M., Breit, S., Plewnia, C., Bender, B., Gharabaghi, A., Wächter, T., et al. (2013) · Brain · doi:10.1093/brain/awt122 · Cited by 214
“Previously, acute depressive (Bejjani et al., 1999; Blomstedt et al., 2008) or hypomanic clinical states (Ulla et al.”
BackgroundNon-motor outcomes depend on location of neurostimulation in Parkinson’s disease
Petry‐Schmelzer, J. N., Krause, M., Dembek, T. A., Horn, A., Evans, J., Ashkan, K., Rizos, A., Silverdale, M., Schumacher, W., Sack, C., et al. (2019) · Brain · doi:10.1093/brain/awz285 · Cited by 162
STN vs. GPi Deep Brain Stimulation: Translating the Rematch into Clinical Practice
Williams, N. R., Foote, K., & Okun, M. (2014) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12004 · Cited by 148
“Even slight errors in placement of the DBS lead can result in current spread into adjacent associative and limbic regions and also into nearby fiber bundles(38) or other nuclei.(39)”
BackgroundGuillory, S. A., & Bujarski, K. A. (2014) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsu002 · Cited by 127
Précis of The Hidden Spring: A Journey to the Source of Consciousness
Solms, M. (2021) · Journal of Consciousness Studies · doi:10.53765/20512201.28.11.153 · Cited by 116
Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease
Paff, M. R., Loh, A., Sarica, C., Lozano, A. M., & Fasano, A. A. (2020) · Journal of Movement Disorders · doi:10.14802/jmd.20052 · Cited by 109
Pal, G. D., Mangone, G., Hill, E. J., Ouyang, B., Liu, Y., Lythe, V., Ehrlich, D. J., Saunders-Pullman, R. J., Shanker, V., Bressman, S., et al. (2022) · Annals of Neurology · doi:10.1002/ana.26302 · Cited by 107
“Given the compact anatomy of STN compared with GPi, the likelihood is higher of unintended current spread into adjacent STN subregions and nearby structures.(13,14) Imaging studies have revealed the likely region of accidental activation is that of nonmotor medial prefrontal–striatal circuitry in those with STN-DBS.”
BackgroundBlomstedt, P. C., Persson, R. S., Hariz, G., Linder, J., Fredricks, A., Häggström, B., Philipsson, J., Forsgren, L., & Hariz, M. I. (2018) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317219 · Cited by 97
Developments in the field of antidepressants, where do we go now?
Artigas, F. (2013) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.04.013 · Cited by 100
“Second, the deep brain stimulation of the substantia nigra pars reticulata (a key area in the function of cortico-basal ganglia– thalamic circuits) evoked an acute and transient depressive state that rapidly disappeared when stimulation ceased (Bejjani et al., 1999; Blomstedt et al., 2008).”
BackgroundArtigas, F., Bortolozzi, A. A., & Celada, P. (2017) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2017.10.032 · Cited by 96
“, 1997); 5) deep brain stimulation of midbrain areas, such as the substantia nigra reticulata, evoked a depressive-like state in Parkinsonian patients, which immediately disappeared after the cessation of the stimulation current (Bejjani et al., 1999; Blomstedt et al., 2008; Tommassi et al., 2008); 6) on the contrary,…”
BackgroundSerotonin-dependent depression in Parkinson’s disease: A role for the subthalamic nucleus?
Tan, S. K. H., Hartung, H., Sharp, T., & Temel, Y. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.01.006 · Cited by 82
Dafsari, H. S., Petry‐Schmelzer, J. N., Chaudhuri, К. R., Ashkan, K., Weis, L., Dembek, T. A., Samuel, M., Rizos, A., Silverdale, M., Barbe, M. T., et al. (2018) · Brain stimulation · doi:10.1016/j.brs.2018.03.009 · Cited by 81
“reports have provided evidence for an induction of acute severe depression by substantia nigra stimulation [40, 41].”
BackgroundSolms, M. (2021) · Journal of the American Psychoanalytic Association · doi:10.1177/00030651211057041 · Cited by 74
Morishita, T., Foote, K. D., Burdick, A. P., Katayama, Y., Yamamoto, T., Frucht, S. J., & Okun, M. S. (2009) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2009.10.003 · Cited by 72
“A recent randomized double-blind study revealed a higher incidence of cognitive adverse events in patients with STN DBS when compared to GPi DBS [23].”
InfluentialComplications and Side Effects of Deep Brain Stimulation in the Posterior Subthalamic Area
Fytagoridis, A., & Blomstedt, P. C. (2010) · Stereotactic and Functional Neurosurgery · doi:10.1159/000271824 · Cited by 67
Transient acute depressive state induced by subthalamic region stimulation
Tommasi, G., Lanotte, M., Albert, U., Zibetti, M., Castelli, L., Maina, G., & Lopiano, L. (2008) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2008.06.012 · Cited by 58
“In view of the probabilistic anatomical localization of the contacts, even if considering the accuracy limitations inherent to this methodology, and the voltage thresholds for the acute mood changes, we could suppose involvement both of the limbic part of the STN and its neighbouring structures, such as the ZI/FF and…”
BackgroundResultFaggiani, E., & Benazzouz, A. (2016) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2016.07.003 · Cited by 57
Postoperative management of deep brain stimulation in Parkinson's disease.
Castrioto, A., Volkmann, J., & Krack, P. (2013) · Handbook of Clinical Neurology · doi:10.1016/b978-0-444-53497-2.00011-5 · Cited by 43
Tan, S. K. H., Janssen, M. L. F., Jahanshahi, A., Chouliaras, L., Visser-Vandewalle, V. E. R. M., Lim, L. W., Steinbusch, H. W. M., Sharp, T., & Temel, Y. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.04.011 · Cited by 45
“Part of the evidence for a role for the SN are case reports that HFS of this brain area induces acute depressive symptoms (Bejjani et al., 1999; Blomstedt et al., 2008).”
BackgroundThe combined depletion of monoamines alters the effectiveness of subthalamic deep brain stimulation
Faggiani, E., Delaville, C., & Benazzouz, A. (2015) · Neurobiology of Disease · doi:10.1016/j.nbd.2015.07.010 · Cited by 43
Deep brain stimulation in the treatment of depression
Blomstedt, P. C., Sjöberg, R. L., Hansson, M., Bodlund, O., & Hariz, M. I. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01625.x · Cited by 44
“Rare, and often transient, side effects of DBS in the subthalamic nucleus in parkinsonian patients, as reported in the literature, include inter alia, acute depression, hypomania and hilarious laughter (20, 48, 49).”
BackgroundPolosan, M., Droux, F., Kibleur, A., Chabardès, S., Bougerol, T., Olivier David, A., Krack, P., & Voon, V. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0404-y · Cited by 40
What are emotions and how are they created in the brain?
Lindquist, K. A., Wager, T. D., Bliss‐Moreau, E., Hedy Kober, A., & Barrett, L. F. (2012) · Behavioral and Brain Sciences · doi:10.1017/s0140525x1100183x · Cited by 38
Panksepp, J. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00081.x · Cited by 35
“A most recent exemplar is evoked sadness/depression (Blomstedt et al., 2007).”
BackgroundRegional anatomy of the pedunculopontine nucleus: Relevance for deep brain stimulation
Fournier‐Gosselin, M., Lipsman, N., Saint‐Cyr, J. A., Hamani, C., & Lozano, A. M. (2013) · Movement Disorders · doi:10.1002/mds.25620 · Cited by 35
“As suggested in a recent case report on bilateral subthalamic nucleus DBS for PD, macrostimulation of the substantia nigra could perhaps induce changes in mood that might be reversible on discontinuation of the stimulation.(23) Macrostimulation of the medioventral PPN region might theoretically generate a contralatera…”
BackgroundAnderson, D., Beecher, G., & Ba, F. (2017) · Parkinson s Disease · doi:10.1155/2017/5124328 · Cited by 34
“Reports of acute depression [78, 79], hypomania [77], and mania [76, 80] secondary to high frequency SN stimulation are evident in the literature.”
BackgroundBrainstem Pathologies Correlate With Depression and Psychosis in Parkinson's Disease
Fischer, N. M., Hinkle, J. T., Perepezko, K. M., Bakker, C. C., Morris, M., Broen, M. P. G., Butala, A., Dawson, T. M., Leentjens, A. F. G., Mari, Z. K., et al. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.12.009 · Cited by 23
“Case reports have also described instances in which SN stimulation during a deep brain stimulation procedure has induced acute depressive episodes in PD patients.(30) Additionally, in the general population, it has been well established that cerebrovascular lesions within the basal ganglia, which receive dopaminergic…”
Tan, S. K. H., Hartung, H., Schievink, S. H. J., Sharp, T., & Temel, Y. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2012.07.032 · Cited by 20
Peeters, J., Boogers, A., Bogaert, T. V., Davidoff, H., Gransier, R., Wouters, J. M., Nuttin, B., & Laughlin, M. M. (2022) · Neuromodulation Technology at the Neural Interface · doi:10.1016/j.neurom.2021.11.002 · Cited by 20
Neurochemical mechanisms of deep brain stimulation for depression in animal models
Campos, A. C. P., Pople, C. B., Silk, E., Surendrakumar, S., Rabelo, T. K., Meng, Y., Gouveia, F. V., Lipsman, N., Giacobbe, P., & Hamani, C. (2023) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.12.003 · Cited by 17
Zhang, F., Wang, F., Xing, Y.-J., Yang, M.-M., Wang, J., Li, C., Han, C., Fan, S., Gao, D.-M., Chen, Y., et al. (2022) · Brain Sciences · doi:10.3390/brainsci12060755 · Cited by 15
“Neurostimulation of DBS increases dopamine levels in the brain [18], and dopamine is closely related to happiness and well-being.”
BackgroundWang, X., Zhang, L., Sperry, L., Olichney, J., Farias, S. T., Shahlaie, K., Malhado-Chang, N., Liu, Y., Wang, S., & Wang, C. (2015) · Chinese Medical Journal · doi:10.4103/0366-6999.171464 · Cited by 15
“with DBS parameter changes have also been described, and are reversible with decrease in current intensity.[87]”
BackgroundKirshenbaum, J. S., Chahal, R., Ho, T. C., King, L. S., Gifuni, A. J., Mastrovito, D., Coury, S. M., Weisenburger, R. L., & Gotlib, I. H. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13512 · Cited by 14
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Solms, M. (2020) · Neuropsychoanalysis · doi:10.1080/15294145.2020.1843215 · Cited by 10
“Thus, SEEKING pre-empts prediction errors such as hunger and thirst; which is why it evolved in the first place, and why notSEEKING, as Clark says, is “depressing” (see Blomstedt et al., 2008 for the depressing effects of SEEKING shutdown).”
BackgroundZhang, F., Wang, F., Li, C., Wang, J., Han, C., Fan, S., Jing, S., Jin, H., Du, L., Liu, W., et al. (2022) · Journal of Neurorestoratology · doi:10.26599/jnr.2022.9040004 · Cited by 10
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Treatment of psychiatric disturbances in hypokinetic movement disorders
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Acute severe depression induced by stimulation of the right globus pallidus internus
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“Some cases have, however, been presented with acute stimulation-induced depression following STN DBS (Blomstedt et al., 2008).”
BackgroundInfluentialDelayed mood transitions in major depressive disorder
Korf, J. (2014) · Medical Hypotheses · doi:10.1016/j.mehy.2014.02.015 · Cited by 8
“For instance, electrical stimulation of the subthalamic nucleus, aimed to alleviate tremor in Parkinson’s disease, evokes a depressed mood within 5 s, which than disappeared within 30 s after cessation of the stimulation [6–9].”
BackgroundTowards Adaptive Deep Brain Stimulation for Non‐Motor Symptoms in Parkinson's Disease?
Swinnen, B. E. K. S., Hoy, C. W., & Little, S. J. (2025) · Movement Disorders · doi:10.1002/mds.30212 · Cited by 7
“136,138,139 Therefore, precise anatomical control of the stimulation fi eld with respect to a speci fi c symptom is key for neuromodulation of non-motor aspects of PD.”
Non‐motor Function of the Midbrain Dopaminergic Neurons
Cunha, C. D., Lovato, E. C. W., Bortolanza, M., Dombrowski, P. A., dos Santos, L. M., Boschen, S. L., Miyoshi, E., Vital, M. A. B. F., Boerngen-Lacerda, R., & Andreatini, R. (2009) · Springer eBooks · doi:10.1007/978-3-211-92660-4_12 · Cited by 7
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Simmons, D. B., & Dashtipour, K. (2015) · Case Reports in Neurological Medicine · doi:10.1155/2015/165846 · Cited by 6
“In a fourth case, the location of the contact inducing the depressive state was inferred but not confirmed since the electrode was repositioned during surgery to have been the right SN [14].”
BackgroundPopova, M., Messé, A., Gulberti, A., Gerloff, C. P., Pötter‐Nerger, M., & Hilgetag, C. C. (2024) · Network Neuroscience · doi:10.1162/netn_a_00376 · Cited by 5
“However, there is a possibility of worsening akinesia (Weiss et al., 2013), hypomania (Ulla et al., 2011), mania (Ulla et al., 2006), and depression (Blomstedt et al., 2008) with SNr stimulation, partly due to projections of the SNr to the limbic system (Pötter-Nerger & Volkmann, 2013).”
Milosevic, L., Dallapiazza, R. F., Munhoz, R. P., Kalia, S. K., Popović, M. R., & Hutchison, W. D. (2019) · Journal of Neurophysiology · doi:10.1152/jn.00203.2019 · Cited by 4
Subthalamic Nucleus Stimulation in Severe Obsessive–Compulsive Disorder
Dettling, M., & Anghelescu, I. (2009) · New England Journal of Medicine · doi:10.1056/nejmc082508 · Cited by 4
NIH Toolbox performance of persons with Parkinson's disease according to GBA1 and STN‐DBS status
Almelegy, A., Gunda, S., Buyske, S. G., Rosenbaum, M., Sani, S., Afshari, M., Metman, L. V., Goetz, C. G., Hall, D. A., Mouradian, M. M., et al. (2024) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.52005 · Cited by 3
“15 Given that GBA1 mutations and STN-DBS are independently associated with cognitive dysfunction in PwP, we hypothesized that PwP with both GBA1 mutations and STN-DBS are at greater risk of cognitive dysfunction than PwP with only GBA1 mutations or STN-DBS, or neither.”
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Solms, M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.24093-5 · Cited by 4
Selective stimulation of the subthalamic nucleus in Parkinson’s disease: dream or near future
Janssen, M. L. F. (2015) · Research Publications (Maastricht University) · doi:10.26481/dis.20150513mj · Cited by 2
Perioperative Emergencies Associated with Deep Brain Stimulation
Morishita, T., Burdick, A. P., & Inoue, T. (2021) · Current clinical neurology · doi:10.1007/978-3-030-75898-1_18 · Cited by 1
Volumetric Evaluation of Substantia Nigra in Major Depressive Disorder Using Atlas-Based Method
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“A study reported an instance in which erroneous deep brain stimulation of the SN resulted in a reversible severe depressive episode (13).”
Mark Solms’s Neuropsychoanalytic Meta-Neuropsychology
Dall’Aglio, J. (2024) · The Palgrave Lacan Series · doi:10.1007/978-3-031-68831-7_6 · Cited by 1
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Corrections to Panksepp (2008)
Barrett, L. F., & Lindquist, K. A. (2008)
Solms, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-29258-3.00045-8
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Metadata
- Authors
- Blomstedt, P., Hariz, M. I., Lees, A., Silberstein, P., Limousin, P., Yelnik, J., & Agid, Y.
- Affiliations
- University Hospital of Umeå (SE)
- National Hospital for Neurology and Neurosurgery (GB)
- Inserm (FR)
- Corresponding author
- Blomstedt, Patric
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 14
- Issue
- 3
- Pages
- 253-256
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W2059958122
- Cited by
- 62
- References
- 12
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 4 · 2014: 4 · 2013: 6 · 2012: 4
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- MeSH terms
- Depression, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Parkinson Disease, Substantia Nigra, Deep Brain Stimulation
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