Skip to main content
SpringerLink
Log in

Subcallosal Cingulate Cortex Deep Brain Stimulation for the Treatment of Refractory Mood Disorders: Evidence and Challenges

  • Chapter
  • First Online:
Deep Brain Stimulation

Abstract

Although deep brain stimulation (DBS) is an accepted therapeutic strategy for the treatment of a number of neurological disorders, the use of DBS for treatment of psychiatric conditions, including treatment-resistant depression (TRD), is a nascent area of investigation. Guided by advances in neurocircuitry models of major depressive disorder, the subcallosal cingulate cortex (SCC) has emerged as one of the putative neuroanatomical targets for stimulation in patients with TRD. Since the first publication of the antidepressant effects of SCC DBS for the treatment of TRD in 2005, several case series have been published. The data from these open-label studies suggest that SCC DBS is associated with robust and sustained antidepressant responses and improved quality of life in patients with TRD and bipolar depression. To optimize patient outcomes, future challenges include understanding the neurophysiological and psychological adaptations that occur with continuous chronic stimulation of the SCC and the development of preoperative predictors of antidepressant response to SCC DBS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abelson JL, Curtis GC, Sagher O, Albucher RC, Harrigan M, Taylor SF, Martis B, Giordani B (2005) Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry 57:510–516

    Article  PubMed  Google Scholar 

  • Albanese A, Piacentini S, Romito LM, Leone M, Franzini A, Broggi G, Bussone G (2005) Suicide after successful deep brain stimulation for movement disorders. Neurology 65:499–500

    Article  PubMed  CAS  Google Scholar 

  • Giacobbe P, Kennedy SH (2009) Medical management and indications for surgery in depression. In: Lozano AM, Gildenberg PL, Tasker RR (eds) Textbook of stereotactic and functional neurosurgery, 2nd edn. Springer, New York, pp 2925–2941

    Google Scholar 

  • Giacobbe P, Mayberg HS, Lozano AM (2009) Treatment resistant depression as a failure of brain homeostatic mechanisms: implications for deep brain stimulation. Exp Neurol 219:44–52

    Article  PubMed  Google Scholar 

  • Giacobbe P, Lipsman N, Hamani C, Lozano AM, Kennedy SH (2010) Subgenual cingulate gyrus deep brain stimulation: current status and future directions. Psychiatr Ann 40:485–491

    Article  Google Scholar 

  • Guinjoan SM, Mayberg HS, Costanzo EY, Fahrer RD, Tenca E, Antico J, Cerquetti D, Smyth E, Leiguarda RC, Nemeroff CB (2010) Asymmetrical contribution of brain structures to treatment-resistant depression as illustrated by effects of right subgenual cingulum stimulation. J Neuropsychiatry Clin Neurosci 22:265–277

    Article  PubMed  Google Scholar 

  • Hamani C, Mayberg H, Snyder B, Giacobbe P, Kennedy S, Lozano AM (2009) Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting. J Neurosurg 111:1209–1215

    Article  PubMed  Google Scholar 

  • Hamani C, Mayberg H, Stone S, Laxton A, Haber S, Lozano AM (2011) The subcallosal cingulate gyrus in the context of major depression. Biol Psychiatry 69:301–308

    Article  PubMed  Google Scholar 

  • Holtzheimer PE, Kelley ME, Gross RE, Filkowski MM, Garlow SJ, Barrocas A, Wint D, Craighead MC, Kozarsky J, Chismar R, Moreines JL, Mewes K, Posse PR, Gutman DA, Mayberg HS (2012) Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry 69:150–158

    Article  PubMed  Google Scholar 

  • Houeto JL, Mallet L, Mesnage V, Tezenas du Montcel S, Béhar C, Gargiulo M, Torny F, Pelissolo A, Welter ML, Agid Y (2006) Subthalamic stimulation in Parkinson disease: behavior and social adaptation. Arch Neurol 63:1090–1095

    Google Scholar 

  • Howard A, Honey CR, Hurwitz TA, Ilcewicz-Klimek M, Woo C, Lam RW, Berman N (2011) Letter to the editor. J Neurosurg (in press)

    Google Scholar 

  • Kennedy SH, Giacobbe P, Rizvi SJ, Placenza FM, Nishikawa Y, Mayberg HS, Lozano AM (2011) Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years. Am J Psychiatry 168:502–510

    Article  PubMed  Google Scholar 

  • Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH (2008) Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 64:461–467

    Article  PubMed  Google Scholar 

  • Lozano AM, Giacobbe P, Hamani C, Rizvi SJ, Kennedy SH, Kolivakis TT, Debonnel G, Sadikot AF, Lam RW, Howard AK, Ilcewicz-Klimek M, Honey CR, Mayberg HS (2012) A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. J Neurosurg 116:315–322

    Article  PubMed  Google Scholar 

  • Mayberg HS (2009) Targeted electrode-based modulation of neural circuits for depression. J Clin Investig 119:717–725

    Article  PubMed  CAS  Google Scholar 

  • Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45:651–660

    Article  PubMed  CAS  Google Scholar 

  • McNab JA, Voets NL, Jenkinson N, Squier W, Miller KL, Goodwin GM, Aziz TZ (2009) Reduced limbic connections may contraindicate subgenual cingulate deep brain stimulation for intractable depression. J Neurosurg 111:780–784

    Article  PubMed  Google Scholar 

  • McNeely HE, Mayberg HS, Lozano AM, Kennedy SH (2008) Neuropsychological impact of Cg25 deep brain stimulation for treatment-resistant depression: preliminary results over 12 months. J Nerv Mental Dis 196:405–410

    Article  Google Scholar 

  • Neimat JS, Hamani C, Giacobbe P, Merskey H, Kennedy SH, Mayberg HS, Lozano AM (2008) Neural stimulation successfully treats depression in patients with prior ablative cingulotomy. Am J Psychiatry 165:687–693

    Article  PubMed  Google Scholar 

  • O’Leary DA, Lee AS (1996) Seven year prognosis in depression: mortality and readmission risk in the Nottingham ECT cohort. Br J Psychiatry 169:423–429

    Article  PubMed  Google Scholar 

  • Puigdemont D, Portella MJ, Pérez-Egea R, de Diego-Adeliño J, Gironell A, Molet J, Duran-Sindreu S, Alvarez E, Pérez V (2009) Depressive relapse after initial response to subcallosal cingulate gyrus-deep brain stimulation in a patient with a treatment-resistant depression: electroconvulsive therapy as a feasible strategy. Biol Psychiatry 66:e11–e12

    Article  PubMed  Google Scholar 

  • Puigdemont D, Pérez-Egea R, Portella MJ, Molet J, de Diego-Adeliño J, Gironell A, Radua J, Gómez-Anson B, Rodríguez R, Serra M, de Quintana C, Artigas F, Alvarez E, Pérez V (2011) Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression. Int J Neuropsychopharmacol 22:1–13

    Google Scholar 

  • Shergill SS, Robertson MM, Stein G, Bernadt M, Katona CLE (1999) Outcome in refractory depression. J Affect Disord 54:287–294

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University Health Network – Toronto General Hospital, University of Toronto, Toronto, Canada

    Peter Giacobbe

  2. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada

    Nir Lipsman & Andres M. Lozano

  3. Division of Neurosurgery, University Health Network – Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Andres M. Lozano

Authors
  1. Peter Giacobbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nir Lipsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andres M. Lozano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Peter Giacobbe or Andres M. Lozano .

Editor information

Editors and Affiliations

  1. , Department of Psychiatry, Academic Medical Center, University of A, PO Box 75867, Amsterdam, 1070 AW, Netherlands

    Damiaan Denys

  2. , Neuromodulation and Behaviour, Netherlands Institute for Neuroscience, Meibergdreef 47, Amsterdam, 1105 BA, Netherlands

    Matthijs Feenstra

  3. , Department of Neurosurger, Academic Medical Center, University of A, Meibergdreef 9, Amsterdam, 1070 AW, Netherlands

    Rick Schuurman

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Giacobbe, P., Lipsman, N., Lozano, A.M. (2012). Subcallosal Cingulate Cortex Deep Brain Stimulation for the Treatment of Refractory Mood Disorders: Evidence and Challenges. In: Denys, D., Feenstra, M., Schuurman, R. (eds) Deep Brain Stimulation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-30991-5_8

Download citation

Publish with us

Policies and ethics

Search

Navigation