Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: A systematic review and exploratory meta-analysis
Abstract Background Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiv...
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| Veröffentlicht in: | Journal of affective disorders 2014-04, Vol.159, p.31-38 |
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| creator | Berlim, Marcelo T McGirr, Alexander Van den Eynde, Frederique Fleck, Marcelo P.A Giacobbe, Peter |
| description | Abstract Background Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis. Methods We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes. Results Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=−1.89 [95% CI=−2.64 to −1.15, p |
| doi_str_mv | 10.1016/j.jad.2014.02.016 |
| format | Article |
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Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis. Methods We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes. Results Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=−1.89 [95% CI=−2.64 to −1.15, p <0.0001]). Also, there was a significant decrease in depression scores between 3 and 6 months (Hedges׳ g =−0.27, p =0.003), but no significant changes from months 6 to 12. Finally, dropout rates at 12 months were 10.8% (95% CI=4.3% to 24.4%). Limitations Small number of included studies (most of which were open label), and limited long-term effectiveness data. Conclusions DBS applied to the SCC seems to be associated with relatively large response and remission rates in the short- and medium- to long-term in patients with severe TRD. Also, its maximal antidepressant effects are mostly observed within the first 6 months after device implantation. Nevertheless, these findings are clearly preliminary and future controlled trials should include larger and more representative samples, and focus on the identification of optimal neuroanatomical sites and stimulation parameters.</description><identifier>ISSN: 0165-0327</identifier><identifier>EISSN: 1573-2517</identifier><identifier>DOI: 10.1016/j.jad.2014.02.016</identifier><identifier>PMID: 24679386</identifier><identifier>CODEN: JADID7</identifier><language>eng</language><publisher>Oxford: Elsevier B.V</publisher><subject>Acceptability ; Adult and adolescent clinical studies ; Biological and medical sciences ; Clinical Trials as Topic ; Cortex ; Deep Brain Stimulation ; Depression ; Depressive Disorder, Treatment-Resistant - therapy ; Effectiveness ; Gyrus Cinguli ; Humans ; Medical sciences ; Miscellaneous ; Mood disorders ; Prospective Studies ; Psychiatry ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Refractory depression ; Remission ; Stimulation ; Treatment Outcome ; Treatment-resistant depression</subject><ispartof>Journal of affective disorders, 2014-04, Vol.159, p.31-38</ispartof><rights>Elsevier B.V.</rights><rights>2014 Elsevier B.V.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c603t-280113f2e223e626f2dcf1a4fc5f4118c897da6538513fa0c7238b546af58dec3</citedby><cites>FETCH-LOGICAL-c603t-280113f2e223e626f2dcf1a4fc5f4118c897da6538513fa0c7238b546af58dec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jad.2014.02.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,30987,45982</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28331619$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24679386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berlim, Marcelo T</creatorcontrib><creatorcontrib>McGirr, Alexander</creatorcontrib><creatorcontrib>Van den Eynde, Frederique</creatorcontrib><creatorcontrib>Fleck, Marcelo P.A</creatorcontrib><creatorcontrib>Giacobbe, Peter</creatorcontrib><title>Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: A systematic review and exploratory meta-analysis</title><title>Journal of affective disorders</title><addtitle>J Affect Disord</addtitle><description>Abstract Background Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis. Methods We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes. Results Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=−1.89 [95% CI=−2.64 to −1.15, p <0.0001]). Also, there was a significant decrease in depression scores between 3 and 6 months (Hedges׳ g =−0.27, p =0.003), but no significant changes from months 6 to 12. Finally, dropout rates at 12 months were 10.8% (95% CI=4.3% to 24.4%). Limitations Small number of included studies (most of which were open label), and limited long-term effectiveness data. Conclusions DBS applied to the SCC seems to be associated with relatively large response and remission rates in the short- and medium- to long-term in patients with severe TRD. Also, its maximal antidepressant effects are mostly observed within the first 6 months after device implantation. Nevertheless, these findings are clearly preliminary and future controlled trials should include larger and more representative samples, and focus on the identification of optimal neuroanatomical sites and stimulation parameters.</description><subject>Acceptability</subject><subject>Adult and adolescent clinical studies</subject><subject>Biological and medical sciences</subject><subject>Clinical Trials as Topic</subject><subject>Cortex</subject><subject>Deep Brain Stimulation</subject><subject>Depression</subject><subject>Depressive Disorder, Treatment-Resistant - therapy</subject><subject>Effectiveness</subject><subject>Gyrus Cinguli</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Mood disorders</subject><subject>Prospective Studies</subject><subject>Psychiatry</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Refractory depression</subject><subject>Remission</subject><subject>Stimulation</subject><subject>Treatment Outcome</subject><subject>Treatment-resistant depression</subject><issn>0165-0327</issn><issn>1573-2517</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkk1v1DAQhiMEoqXwA7ggX5DKIYs_EscBCamU8iFV4lA4W15nXLwkzmI7pfll_D0m7AISB7Qny-Nn3pnxvEXxmNEVo0w-36w2pltxyqoV5SuM3CmOWd2IktesuVscY6QuqeDNUfEgpQ2lVLYNvV8c8Uo2rVDyuPhx4RzY7G8gQErEhI4Ya2Gbzdr3Ps9kdKQD2JJ1ND6QlP0w9Sb7MZDTN6-vni3v-QuQNK2vIUymJ9aH6wUBYseY4Za4MZIcweQBQi4jJJ-yCRllt3hJKPWCnJE0pwwDKlsS4cbD91-9wO22H6PJY5zJANmUJph-RoWHxT1n-gSP9udJ8fntxafz9-Xlx3cfzs8uSyupyCVXlDHhOHAuQHLpeGcdM5WztasYU1a1TWdkLVSNmKG24UKt60oaV6sOrDgpTne62zh-myBlPfhkoe9NgHFKmtUVa5vlWw9ARaWYark4AOVcKtpiNwegVEgcpUWU7VAbx5QiOL2NfjBx1ozqxTB6o9EwejGMplxjBHOe7OWn9QDdn4zfDkHg6R4wyZreRROsT385JQSTbCn-cscBbgP3F3WyHoKFzkc0mO5G_982Xv2TbXsfPBb8CjOkzThFXDxOqxMm6KvF2YuxWYWmrislfgJJ-_T4</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Berlim, Marcelo T</creator><creator>McGirr, Alexander</creator><creator>Van den Eynde, Frederique</creator><creator>Fleck, Marcelo P.A</creator><creator>Giacobbe, Peter</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><scope>7QJ</scope></search><sort><creationdate>20140401</creationdate><title>Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: A systematic review and exploratory meta-analysis</title><author>Berlim, Marcelo T ; McGirr, Alexander ; Van den Eynde, Frederique ; Fleck, Marcelo P.A ; Giacobbe, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c603t-280113f2e223e626f2dcf1a4fc5f4118c897da6538513fa0c7238b546af58dec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acceptability</topic><topic>Adult and adolescent clinical studies</topic><topic>Biological and medical sciences</topic><topic>Clinical Trials as Topic</topic><topic>Cortex</topic><topic>Deep Brain Stimulation</topic><topic>Depression</topic><topic>Depressive Disorder, Treatment-Resistant - therapy</topic><topic>Effectiveness</topic><topic>Gyrus Cinguli</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Mood disorders</topic><topic>Prospective Studies</topic><topic>Psychiatry</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Refractory depression</topic><topic>Remission</topic><topic>Stimulation</topic><topic>Treatment Outcome</topic><topic>Treatment-resistant depression</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berlim, Marcelo T</creatorcontrib><creatorcontrib>McGirr, Alexander</creatorcontrib><creatorcontrib>Van den Eynde, Frederique</creatorcontrib><creatorcontrib>Fleck, Marcelo P.A</creatorcontrib><creatorcontrib>Giacobbe, Peter</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><jtitle>Journal of affective disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berlim, Marcelo T</au><au>McGirr, Alexander</au><au>Van den Eynde, Frederique</au><au>Fleck, Marcelo P.A</au><au>Giacobbe, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: A systematic review and exploratory meta-analysis</atitle><jtitle>Journal of affective disorders</jtitle><addtitle>J Affect Disord</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>159</volume><spage>31</spage><epage>38</epage><pages>31-38</pages><issn>0165-0327</issn><eissn>1573-2517</eissn><coden>JADID7</coden><abstract>Abstract Background Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis. Methods We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes. Results Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=−1.89 [95% CI=−2.64 to −1.15, p <0.0001]). Also, there was a significant decrease in depression scores between 3 and 6 months (Hedges׳ g =−0.27, p =0.003), but no significant changes from months 6 to 12. Finally, dropout rates at 12 months were 10.8% (95% CI=4.3% to 24.4%). Limitations Small number of included studies (most of which were open label), and limited long-term effectiveness data. Conclusions DBS applied to the SCC seems to be associated with relatively large response and remission rates in the short- and medium- to long-term in patients with severe TRD. Also, its maximal antidepressant effects are mostly observed within the first 6 months after device implantation. Nevertheless, these findings are clearly preliminary and future controlled trials should include larger and more representative samples, and focus on the identification of optimal neuroanatomical sites and stimulation parameters.</abstract><cop>Oxford</cop><pub>Elsevier B.V</pub><pmid>24679386</pmid><doi>10.1016/j.jad.2014.02.016</doi><tpages>8</tpages></addata></record> |
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| subjects | Acceptability Adult and adolescent clinical studies Biological and medical sciences Clinical Trials as Topic Cortex Deep Brain Stimulation Depression Depressive Disorder, Treatment-Resistant - therapy Effectiveness Gyrus Cinguli Humans Medical sciences Miscellaneous Mood disorders Prospective Studies Psychiatry Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Refractory depression Remission Stimulation Treatment Outcome Treatment-resistant depression |
| title | Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: A systematic review and exploratory meta-analysis |
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