A pilot study of bed nucleus of the stria terminalis deep brain stimulation in treatment-resistant depression

Paul B. Fitzgerald; Rebecca Segrave; Karyn E. Richardson; Laura A. Knox; Sally Herring; Zafiris J. Daskalakis; Richard G. Bittar

doi:10.1016/j.brs.2018.04.013

A pilot study of bed nucleus of the stria terminalis deep brain stimulation in treatment-resistant depression

Paul B. Fitzgerald^*, Rebecca Segrave, Karyn E. Richardson, Laura A. Knox, Sally Herring, Zafiris J. Daskalakis, Richard G. Bittar

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

Abstract

Background: Studies are increasingly investigating the therapeutic effects of deep brain stimulation (DBS) applied to a variety of brain regions in the treatment of patients with highly treatment refractory depression. Limited research to date has investigated the therapeutic potential of DBS applied to the Bed Nucleus Of Stria Terminalis (BNST). Objective: The aim of this study was to explore the therapeutic potential of DBS applied to the BNST. Method: Five patients with highly treatment resistant depression underwent DBS to the BNST in an open label case series design. Results: BNST DBS resulted in sustained remission of depression in two of the five patients, provided substantial therapeutic improvement two further patients, and had minimal antidepressant effect for the final patient. There were no operative complications and stimulation related side effects were limited and reversible with adjustment of stimulation. However, the time to achieve and complexity of programming required to achieve optimal therapeutic outcomes varied substantially between patients. Conclusion: DBS applied to the BNST as therapeutic potential in patients with highly refractory depression and warrants exploration in larger clinical studies.

Original language	English
Pages (from-to)	921-928
Number of pages	8
Journal	Brain Stimulation
Volume	11
Issue number	4
DOIs	https://doi.org/10.1016/j.brs.2018.04.013
Publication status	Published - 1 Jul 2018
Externally published	Yes

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title = "A pilot study of bed nucleus of the stria terminalis deep brain stimulation in treatment-resistant depression",

abstract = "Background: Studies are increasingly investigating the therapeutic effects of deep brain stimulation (DBS) applied to a variety of brain regions in the treatment of patients with highly treatment refractory depression. Limited research to date has investigated the therapeutic potential of DBS applied to the Bed Nucleus Of Stria Terminalis (BNST). Objective: The aim of this study was to explore the therapeutic potential of DBS applied to the BNST. Method: Five patients with highly treatment resistant depression underwent DBS to the BNST in an open label case series design. Results: BNST DBS resulted in sustained remission of depression in two of the five patients, provided substantial therapeutic improvement two further patients, and had minimal antidepressant effect for the final patient. There were no operative complications and stimulation related side effects were limited and reversible with adjustment of stimulation. However, the time to achieve and complexity of programming required to achieve optimal therapeutic outcomes varied substantially between patients. Conclusion: DBS applied to the BNST as therapeutic potential in patients with highly refractory depression and warrants exploration in larger clinical studies.",

keywords = "Bed nucleus of the stria terminalis, Clinical response, Deep brain stimulation, Major depression, Treatment resistance",

author = "Fitzgerald, {Paul B.} and Rebecca Segrave and Richardson, {Karyn E.} and Knox, {Laura A.} and Sally Herring and Daskalakis, {Zafiris J.} and Bittar, {Richard G.}",

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AU - Herring, Sally

AU - Daskalakis, Zafiris J.

AU - Bittar, Richard G.

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N2 - Background: Studies are increasingly investigating the therapeutic effects of deep brain stimulation (DBS) applied to a variety of brain regions in the treatment of patients with highly treatment refractory depression. Limited research to date has investigated the therapeutic potential of DBS applied to the Bed Nucleus Of Stria Terminalis (BNST). Objective: The aim of this study was to explore the therapeutic potential of DBS applied to the BNST. Method: Five patients with highly treatment resistant depression underwent DBS to the BNST in an open label case series design. Results: BNST DBS resulted in sustained remission of depression in two of the five patients, provided substantial therapeutic improvement two further patients, and had minimal antidepressant effect for the final patient. There were no operative complications and stimulation related side effects were limited and reversible with adjustment of stimulation. However, the time to achieve and complexity of programming required to achieve optimal therapeutic outcomes varied substantially between patients. Conclusion: DBS applied to the BNST as therapeutic potential in patients with highly refractory depression and warrants exploration in larger clinical studies.

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A pilot study of bed nucleus of the stria terminalis deep brain stimulation in treatment-resistant depression

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