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352 The APA Publishing Textbook of Mood Disorders, Second Edition
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APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression
Target and
reference
Subgenual cingulate gyrus/Cg 25
Eitan et al.
2018
Merkl et al.
2018
Riva-Posse
et al. 2018
9 13 months 13 months ≥40%
8 24 months 28 months to
11 12 months 12 months ≥ 50%
End
of study
Maximum
follow-up
reported
4years
reduction
in MADRS
score
≥50%
reduct ion in
score
reduct ion in
score
Response Remission
Time point NA:
44.4
6 months: 37.5 6 months :
12 months: 43
24 months: 33 12 months:
28 months: 33
6 months: 72.7 6 months :
12 months: 81.8
NA NA — High- vs. low-
score ≤10
score ≤7
12.5
14.2
24 months:
33.3
28 months:
33.3
45.4
12 months:
54.5
Comment on
study design N Definition Rate (%) Definition Rate (%) Sample
frequency
stimulation
Over lap with
sampl e
described in
Merk l
et al. 2013
— Pilot st udy on
4 weeks blinded
sh am or activ e
stimulation
the utility of a
prospectiv e
connectomic
approach for
surgery
The APA Publishing Textbook of Mood Disorders, Second Edition
APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression (continued)
Vagus Nerve Stimulation and Deep Brain Stimulatio
Target and
reference
Holtzheimer
et al. 2017
Accolla et al.
2016
Perez-
Caballero
et al. 2014
Maximum Response Remission
End follow-up Comment on
N of study reported Definition Rate (%) Definition Rate (%) Sample study design
90 12 months 24 months ≥40%
reduction
in MADRS
score
5 NA 6 months ≥50%
reduct ion in
and BD I
scores
8 NA 1 month ≥ 50%
reduct ion in
score
6 months: MADRS score
20 (stimulation
group)
17 (control
group)
12 months:
30 (stimulation
group)
27 (control
group)
18 months:
51 (of all
patients)
24 months:
48 (of all
patients)
1 mont h: 37.5 HAMD-17
≤10
score ≤8
6 months: 1 0
(stimulation
group)
7 (control
group)
12 months: 18
(stimulation
group)
7 (control
group)
18 months:
17 (of all
patients)
24 months:
25 (of all
patients)
1 mont h: 25 Subsample of
— 6-month blinded
sampl e
described in
Merkl et al.
2013
Puigdemon t
et al. 2012
sham/active
stimulation study
stopped after
futility analysis
Double-blind
selection of best
contact pair for
stimulation,
including 24-hour
sham
Retrospective
analysis of influ ence
of analgesic/antiinflammatory drugs
357
APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression (continued)
358
Target and
reference
Subgenual cingulate gyrus/Cg 25 (continued)
Ramasubbu
et al. 2013
Merkl et al.
2013
Lozano et al.
2012
Puigdemont
et al. 2012
N of study reported Definition Rate (%) Definition Rate (%) Sample study design
21 12 months
End follow-up Comment on
4 9 months 9 months ≥ 50%
6 6 months
8 12 months 12 months ≥50%
Maximum Response Remission
reduct ion in
score
6–9 months ≥50%
reduct ion in
score
12 months ≥50%
reduct ion in
score
reduct ion in
score
3.5 months: 25 NA NA — 12-week
9 months: 50
6 months: 33.3
1 mont h: 57
6 months: 48
12 months: 29
1 week: 87.5 HAMD-17
1 mont h: 37.5 1 mont h: NA
6 months: 87.5 6 months: 37.5
12 months: 62.5% 12 months: 50
score <10
NA NA — Multicenter pilot
score ≤7
6 months: 33.3 — Double-blind,
1 week: 50
The APA Publishing Textbook of Mood Disorders, Second Edition
double-blind
optimization phas e,
including 2 weeks
of sham
high-intensity
stimulation for
5days, followed b y
open-label study
study
— Prelimi nary findings
of prerandomization
phase of an RCT
APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression (continued)
Vagus Nerve Stimulation and Deep Brain Stimulatio
Target and
reference
Holtzheimer
et al. 2012
Kennedy et al.
2011
Lozano et al.
2008
Mayberg et al.
2005
Maximum Response Remission
End follow-up Comment on
N of study reported Definition Rate (%) Definition Rate (%) Sample study design
17 6 months 24 months ≥50%
reduct ion in
HAMD -17
score
20 NA 6 years ≥50%
reduct ion in
HAMD -17
score
20 12 months 12 months
6 6 months 6 months ≥ 50%
≥50%
reduct ion in
score
reduct ion in
score
6 months: 41
12 months: 36
24 months: 92
1 year: 62.5 HAMD-17
2 years: 46.2 2 years: 15.4
3 years: 75 3 years: 50
Last follow-up:
64.3
1 mont h: 35 HAMD-17
6 months: 60 6 months: 35
12 months: 55 12 months: 35
1 mont h: 33.3 HAMD-17
2 months: 83.3 2 months: 0
6 months: 66.6 6 months: 33.3
score ≤7
score ≤7
score ≤7
score ≤8
6 months: 18
12 months: 36
24 months: 58
1 year: 18.8 Same sample
Last follow-
up: 42.9
1 mont h: 10 Extended
1 mont h: 0 — Blinded stimulation
— Single-blind
discontinuation
phase (after 4 w eeks
of single-blind sham
and 24 weeks of
active stimulat ion)
was stopped after
3 patients relapsed
Long-term follow-up
as described
in Loza no
et al. 2008
sample of
Mayberg
et al. 2005
Blinded stimulation
during the
immedi ate
postoperative
period
during the
immedi ate
postoperative
period
359
APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression (continued)
360
Target and
reference
Ventral capsule/Ventral striatum
Dougherty
et al. 2015
Malone 2010 17 NA 14–67 months ≥ 50%
Malone et al.
2009
N of study reported Definition Rate (%) Definition Rate (%) Sample study design
30
15 NA 6–51 months
End follow-up Comment on
12 months
plus
long-term
follow-up
24 months ≥50%
reduct ion in
MADRS
score
reduction
in MADRS
score
≥50%
reduct ion in
score
Maximum Response Remission
4 months:
20 (stimulation
group)
14.3 (contr ol
group)
12 months: 20
(of all patients)
24 months: 23.3
(of all patients)
3 months: 53 MADRS
6 months: 47 6 months: 29
12 months: 53 12 months: 41
Last follow-up: 71 Last follow-
3 months: 46.7
6 months: 40
Last follow-up:
53.3
MADRS
score ≤10
score ≤11
score ≤10
12 months:
13 (of all
patients)
24 months:
20 (of all
patients)
3 months: 35 Slightly
up: 35
3 months: 20
6 months: 20
Last follow-
up: 40
— Randomi zed
extended
sampl e
(+ 2 patients)
of Malone
et al. 2009
— Multicenter
controlled blinded
phase for 4 months,
followed by openlabel stimulation
Multicen ter
pilot study
pilot study
The APA Publishing Textbook of Mood Disorders, Second Edition
APPENDIX
https://t.me/med1917
ABLE 20–A. Findings from published studies of deep brain stimulation (DBS) targets for treatment-resistant
T
depression (continued)
Vagus Nerve Stimulation and Deep Brain Stimulatio
Target and
reference
Anterior limb of the internal capsule
Raymaekers
et al. 2017
Bergfeld
et al. 2016
N of study reported Definition Rate (%) Definition Rate (%) Sample study design
25 Maximum of
End follow-up Comment on
7 NA 36–97 months ≥50%
64 weeks
Maximum Response Remission
reduct ion in
score
NA ≥ 50%
reduct ion in
score
3 years: 71.4
Last follow-up:
71.4
~12 months: 40 HAMD-17
score ≤7
score ≤7
3 years: 28.6
Last follow-
up: 28.6
~12 months: 20 — Open-label
— Double-blind
crossover;
stimulation target
was varied
systematically
between ALIC,
BNST, and ITP
stimulation for
maximum of 1 year
until response
stable for ≥4 weeks,
followed by 2× 6
weeks blinded
crossover sham/
active stimulation
361
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