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Background: Applying deep brain stimulation (DBS) to several brain regions has been investigated in attempts to treat highly treatment-resistant depression, with variable results. Our initial pilot data suggested that the bed nucleus of the stria terminalis (BNST) could be a promising therapeutic target.
Objective: The aim of this study was to gather blinded data exploring the efficacy of applying DBS to the BNST in patients with highly refractory depression.
Method: Eight patients with chronic severe treatment-resistant depression underwent DBS to the BNST. A randomised, double-blind crossover study design with fixed stimulation parameters was followed and followed by a period of open-label stimulation.
Results: During the double-blind crossover phase, no consistent antidepressant effects were seen with any of the four stimulation parameters applied, and no patients achieved response or remission criteria during the blinded crossover phase or during a subsequent period of three months of blinded stimulation. Stimulation-related side effects, especially agitation, were reported by a number of patients and were reversible with adjustment of the stimulation parameters.
Conclusions: The results of this study do not support the application of DBS to the BNST in patients with highly resistant depression or ongoing research utilising stimulation at this brain site. The blocked randomised study design utilising fixed stimulation parameters was poorly tolerated by the participants and does not appear suitable for assessing the efficacy of DBS at this location.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11118510 | PMC |
| http://dx.doi.org/10.3390/brainsci14050499 | DOI Listing |
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Article Synopsis
- Treatment-resistant depression (TRD) is a challenging mental health issue that doesn't respond well to standard treatments, and this study explores deep brain stimulation (DBS) targeting the bed nucleus of the stria terminalis (BNST) and nucleus accumbens (NAc) as a possible solution.
- The study involved 23 TRD patients who underwent DBS, and results showed that 14 patients improved significantly, with 7 achieving full clinical remission based on the Hamilton Depression Rating Scale (HAMD-17).
- Findings indicated that the BNST may play a more crucial role than the NAc in alleviating symptoms, and the most effective stimulation areas were identified as closely related to the BNST.
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