A longitudinal study on deep brain stimulation of the medial forebrain bundle for treatment-resistant depression
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Abstract Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle (MFB) has been reported to lead to rapid antidepressant effects. In this longitudinal study, we expand upon the initial results we reported at 26 weeks (Fenoy et al., 2016), showing sustained antidepressant effects of MFB DBS on six patients with treatment-resistant depression (TRD) over 1 year. The Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary assessment tool. Deterministic fiber tracking was used to individually map the target area; analysis was performed to compare modulated fiber tracts between patients. Intraoperatively, upon stimulation at target, responders reported immediate increases in energy and motivation. An insertional effect was seen during the 4-week sham stimulation phase from baseline (28% mean MADRS reduction,p = 0.02). However, after 1 week of initiating stimulation, three of six patients had a > 50% decrease in MADRS scores relative to baseline (43% mean MADRS reduction,p = 0.005). One patient withdrew from study participation. At 52 weeks, four of remaining five patients have > 70% decrease in MADRS scores relative to baseline (73% mean MADRS reduction,p = 0.007). Evaluation of modulated fiber tracts reveals significant common orbitofrontal connectivity to the target region in all responders. Neuropsychological testing and18F-fluoro-deoxyglucose-positron emission tomography cerebral metabolism evaluations performed at baseline and at 52 weeks showed minimal changes and verified safety. This longitudinal evaluation of MFB DBS demonstrated rapid antidepressant effects, as initially reported by Schlaepfer et al. (2013), and supports the use of DBS for TRD.
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In the open-label phase of the Fenoy et al. study, the response rate at 1 week of MFB DBS was 50%.
“promising response and remission rates were observed at 1 week of MFB DBS (RS: 50%)”
From Deep brain stimulation for depression. (2022) · cites this paper as [71]
In the Fenoy et al. single-blind phase, no significant difference was found between blinded on and off conditions.
“Results do not indicate any significant difference between blinded on/off conditions”
From Deep brain stimulation for depression. (2022) · cites this paper as [71]
In the open-label phase of the Fenoy et al. study, at 1 year the response rate was 66% and the remission rate was 50%.
“at 1 year (RS: 66%, RM: 50%)”
From Deep brain stimulation for depression. (2022) · cites this paper as [71]
Carryover antidepressant effects of at least 1 week have been observed after transient intraoperative SCC or MFB stimulation.
“carryover antidepressant effects of at least 1 week have been observed after transient intraoperative stimulation of the SCC [81] or MFB [71]”
From Deep brain stimulation for depression. (2022) · cites this paper as [71]
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- Authors
- Fenoy, A. J., Schulz, P. E., Selvaraj, S., Burrows, C. L., Zunta-Soares, G., Durkin, K., Zanotti-Fregonara, P., Quevedo, J., & Soares, J. C.
- Affiliations
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Fenoy, Albert J.
- Venue
- Translational Psychiatry
- Published
- 2018-06-04
- Volume
- 8
- Issue
- 1
- Pages
- 111-111
- ISSN
- 2158-3188 (ISSN-L)
- PMC
- PMC5986795
- OpenAlex
- W2805696691
- Cited by
- 118
- References
- 54
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 19 · 2023: 15 · 2022: 17 · 2021: 24 · 2020: 16 · 2019: 9 · 2018: 1
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Translational Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Medtronic
- John S. Dunn Foundation
- National Institutes of Health (UL1TR000371)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- deep brain stimulation, medial forebrain bundle, treatment-resistant depression, deterministic fiber tracking, sham stimulation, brain glucose metabolism
- MeSH terms
- Adult, Female, Humans, Longitudinal Studies, Male, Medial Forebrain Bundle, Middle Aged, Motivation, Neuropsychological Tests, Psychiatric Status Rating Scales, Texas, Treatment Outcome, Deep Brain Stimulation, Positron-Emission Tomography, Young Adult, Depressive Disorder, Treatment-Resistant
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