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Long-Term Neuropsychological Safety of Subgenual Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression
Nicholas M. Bogod, Ph.D., R.Psych.; Marci Sinden, B.A.; Cindy Woo, B.A.; Vanessa G. DeFreitas, M.A.; Ivan J. Torres, Ph.D., R.Psych.; Andrew K. Howard, M.D., F.R.C.P.C.; Magdalena I. Ilcewicz-Klimek, M.D., F.R.C.P.C.; Christopher R. Honey, M.D., F.R.C.S.C.; Lakshmi N. Yatham, M.B.B.S., M.B.A. (Exec); Raymond W. Lam, M.D., F.R.C.P.C.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:126-133. doi:10.1176/appi.neuropsych.12110287
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Nicholas M. Bogod: St. Jude Medical.

Ivan J. Torres: Canadian Institutes of Health Research.

Andrew K. Howard: St. Jude Medical.

Christopher R. Honey: British Columbia Health Research Foundation, Canadian Institutes of Health Research, Cyberonics, Medical Research Council of Canada, Medtronic of Canada Ltd., PhotoTherapeutics, St. Jude Medical, Titan Pharmaceuticals, Vancouver Coastal Health Authority, VGH and UBC Hospital Foundation, and U.S. patent (US 6,364,907 B1) for “Method to prevent xenograft transplant rejection.”

Lakshmi N. Yatham: AstraZeneca, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Lundbeck, the Michael Smith Foundation for Health Research, Novartis, Otsuka, Pfizer, Ranbaxy, Servier, and the Stanley Foundation.

Raymond W. Lam: AstraZeneca, Biovail, BrainCells, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Canadian Psychiatric Association, Canadian Psychiatric Research Foundation, Common Drug Review, Eli Lilly, Litebook Company Ltd., Lundbeck, Lundbeck Institute, Mathematics of Information Technology and Advanced Computing Systems, Michael Smith Foundation for Health Research, Pfizer Canada, Servier, St. Jude Medical, Takeda, UBC Institute of Mental Health/Coast Capital Savings Depression Research Fund, and Wyeth.

All other authors report no financial relationships with commercial interests.

The DBS pilot and long-term follow-up studies were funded by St. Jude Medical.

The authors thank scientific and technical advice from Dr. Alexander I. Tröster (Barrow Neurological Institute, Phoenix) and Dr. Nancy J. Wilde (Wilde Consulting).

The authors dedicate this article to the memory of Dr. Kathleen R. Stamback.

From the Vancouver General Hospital (NMB, MS, CRH); Division of Neurology, Dept. of Medicine, University of British Columbia (NMB); Dept. of Psychiatry, University of British Columbia and UBC Hospital (CW, IJT, AKH, MII-K, LNY, RWL); Division of Neurosurgery, Dept. of Surgery, University of British Columbia and Vancouver General Hospital (CRH); Dept. of Psychology, Simon Fraser University (VGDF); BC Mental Health and Addictions Services (IJT); and Psychology, QEII Health Sciences Centre (VGDF).

Send correspondence to Dr. Lam; e-mail: r.lam@ubc.ca

Copyright © 2014 by the American Psychiatric Association

Received November 22, 2012; Revised March 19, 2013; Accepted March 26, 2013.


Deep brain stimulation (DBS) of the subgenual cingulate gyrus (SCG) is a promising investigational intervention for treatment-resistant depression (TRD), but long-term outcome data are limited. Serial neuropsychological evaluations, using a comprehensive battery, were conducted on four subjects with TRD prior to surgery, and up to 42 months post-operatively. Reliable change methodology suggested general stability and/or select statistically reliable improvement in cognitive abilities over time. This is the first known set of multi-year neuropsychological follow-up data for SCG DBS for TRD. Observed improvements are likely attributable to reduced depressive symptomatology, recovery of functional capacities, and/or specific practice effects of repeated assessment.

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TABLE 1.Patient Demographics
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S, subject; MDD, major depressive disorder; ECT, electroconvulsive therapy; HRSD–17, Hamilton Rating Scale for Depression (17 item); IDS, Inventory of Depressive Symptomatology; MADRS, Montgomery-Åsberg Depression Rating Scale; NAART, North American Adult Reading Test; IQ, intelligence quotient.

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TABLE 2.Summary of Clinical Assessments Across Time
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TABLE 3.Selected Neuropsychological Results Across Time
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LTFU, long-term follow-up (average of 42 months).

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Results presented in z-scores based on published normative data. General intellectual ability: Wechsler Adult Intelligence Scale–III (WAIS–III) Full Scale IQ; verbal delayed recall–list learning: California Verbal Learning Test–2 standard and alternate forms; verbal delayed recall–story recall: Wechsler Memory Scales–III (WMS–III) Logical Memory; visual delayed recall: WMS-III Family Pictures; verbal fluency – phonemic: Delis Kaplan Executive Function System (DKEFS); verbal fluency–category: DKEFS; executive function–switching: DKEFS Fluency Switching; executive function–inhibition: DKEFS Color-word interference test; visual perception: Benton Visual Form Discrimination Test; attention/working memory: WAIS-III Working Memory Index; processing speed: WAIS III Processing Speed Index.

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a De notes statistically reliable improvement compared with baseline.

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b Denotes statistically reliably decline compared with baseline.

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Underlined scores represent scores falling within the “Impaired” range defined as 1.4 SD below the mean or greater.38

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TABLE 4.Summary of Medications Across Study Duration


Blomstedt  P;  Sjöberg  RL;  Hansson  M  et al:  Deep brain stimulation in the treatment of depression.  Acta Psychiatr Scand 2011; 123:4–11
[CrossRef] | [PubMed]
Bewernick  BH;  Hurlemann  R;  Matusch  A  et al:  Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression.  Biol Psychiatry 2010; 67:110–116
[CrossRef] | [PubMed]
Jiménez  F;  Velasco  F;  Salin-Pascual  R  et al:  A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle.  Neurosurgery 2005; 57:585–593, discussion 585–593
[CrossRef] | [PubMed]
Kennedy  SH;  Giacobbe  P;  Rizvi  SJ  et al:  Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years.  Am J Psychiatry 2011; 168:502–510
[CrossRef] | [PubMed]
Malone  DA  Jr;  Dougherty  DD;  Rezai  AR  et al:  Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression.  Biol Psychiatry 2009; 65:267–275
[CrossRef] | [PubMed]
Sartorius  A;  Kiening  KL;  Kirsch  P  et al:  Remission of major depression under deep brain stimulation of the lateral habenula in a therapy-refractory patient.  Biol Psychiatry 2010; 67:e9–e11
[CrossRef] | [PubMed]
Douglas  KM;  Porter  RJ:  Longitudinal assessment of neuropsychological function in major depression.  Aust N Z J Psychiatry 2009; 43:1105–1117
[CrossRef] | [PubMed]
Gotlib  IH;  Joormann  J:  Cognition and depression: current status and future directions.  Annu Rev Clin Psychol 2010; 6:285–312
[CrossRef] | [PubMed]
Hasselbalch  BJ;  Knorr  U;  Kessing  LV:  Cognitive impairment in the remitted state of unipolar depressive disorder: a systematic review.  J Affect Disord 2011; 134:20–31
[CrossRef] | [PubMed]
Marvel  CL;  Paradiso  S:  Cognitive and neurological impairment in mood disorders.  Psychiatr Clin North Am 2004; 27:19–36, vii–viii
[CrossRef] | [PubMed]
Moore  DJ;  Moseley  S;  Atkinson  JH:  The influence of depression on cognition and daily functioning, in  The Neuropsychology of Everyday Functioning . Edited by Marcotte  TD;  Grant  I.  New York, London,  Guilford Press, 2010, pp 419–440
Hamani  C;  Mayberg  H;  Stone  S  et al:  The subcallosal cingulate gyrus in the context of major depression.  Biol Psychiatry 2011; 69:301–308
[CrossRef] | [PubMed]
Semkovska  M;  McLoughlin  DM:  Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis.  Biol Psychiatry 2010; 68:568–577
[CrossRef] | [PubMed]
Wadsworth  EJK;  Moss  SC;  Simpson  SA  et al:  SSRIs and cognitive performance in a working sample.  Hum Psychopharmacol 2005; 20:561–572
[CrossRef] | [PubMed]
Voon  V;  Kubu  C;  Krack  P  et al:  Deep brain stimulation: neuropsychological and neuropsychiatric issues.  Mov Disord 2006; 21(Suppl 14):S305–S327
[CrossRef] | [PubMed]
York  MK;  Wilde  EA;  Simpson  R  et al:  Relationship between neuropsychological outcome and DBS surgical trajectory and electrode location.  J Neurol Sci 2009; 287:159–171
[CrossRef] | [PubMed]
Grubert  C;  Hurlemann  R;  Bewernick  BH  et al:  Neuropsychological safety of nucleus accumbens deep brain stimulation for major depression: effects of 12-month stimulation.  World J Biol Psychiatry 2011; 12:516–527
[CrossRef] | [PubMed]
McNeely  HE;  Mayberg  HS;  Lozano  AM  et al:  Neuropsychological impact of Cg25 deep brain stimulation for treatment-resistant depression: preliminary results over 12 months.  J Nerv Ment Dis 2008; 196:405–410
[CrossRef] | [PubMed]
Lozano  AM;  Giacobbe  P;  Hamani  C  et al:  A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression.  J Neurosurg 2012; 116:315–322
[CrossRef] | [PubMed]
American Psychiatric Association:  Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision.  Washington, DC,  American Psychiatric Press, 2000
Blair  JR;  Spreen  O:  Predicting premorbid IQ: a revision of the National Adult Reading Test.  Clin Neuropsychol 1989; 3:129–136
Wechsler  D:  Wechsler Adult Intelligence Scale , 3rd ed.  San Antonio, TX,  Harcourt Assessment, 1997
Wechsler  D:  Wechsler Memory Scale , 3rd ed.  San Antonio, TX,  Harcourt Assessment, 1997
Delis  DC;  Kaplan  E;  Kramer  JJ:  The Delis-Kaplan Executive Function System: Examiner’s Manual .  San Antonio, TX,  The Psychological Corporation, 2001
Delis  DC;  Kaplan  E;  Kramer  JJ:  The Delis-Kaplan Executive Function System: Technical Manual .  San Antonio, TX,  The Psychological Corporation, 2001
Delis  DC;  Kramer  JH;  Kaplan  E  et al:  The California Verbal Learning Test , 2nd ed.  San Antonio,  The Psychological Corporation, 2000
Benton  AL;  Sivan  AB;  Hamsher  K  et al:  Contributions to Neuropsychological Assessment , 2nd ed.  New York,  Oxford University Press, 1994
Kaplan  E;  Goodglass  H;  Weintrab  S:  The Boston Naming Test .  Philadelphia,  Lea & Febiger, 1983
Spreen  O;  Strauss  E:  A Compendium of Neuropsychological Tests: Administration, Norms and Commentary , 2nd ed.  New York,  Oxford University Press, 1998
Montgomery  SA;  Asberg  M:  A new depression scale designed to be sensitive to change.  Br J Psychiatry 1979; 134:382–389
[CrossRef] | [PubMed]
Hamilton  M:  A rating scale for depression.  J Neurol Neurosurg Psychiatry 1960; 23:56–62
Rush  AJ;  Giles  DE;  Schlesser  MA  et al:  The Inventory for Depressive Symptomatology (IDS): preliminary findings.  Psychiatry Res 1986; 18:65–87
[CrossRef] | [PubMed]
Rush  AJ;  Gullion  CM;  Basco  MR  et al:  The Inventory of Depressive Symptomatology (IDS): psychometric properties.  Psychol Med 1996; 26:477–486
[CrossRef] | [PubMed]
Jacobson  NS;  Truax  P:  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.  J Consult Clin Psychol 1991; 59:12–19
[CrossRef] | [PubMed]
Burdick  KE;  Endick  CJ;  Goldberg  JF:  Assessing cognitive deficits in bipolar disorder: are self-reports valid? Psychiatry Res 2005; 136:43–50
[CrossRef] | [PubMed]
Lahr  D;  Beblo  T;  Hartje  W:  Cognitive performance and subjective complaints before and after remission of major depression.  Cogn Neuropsychiatry 2007; 12:25–45
[CrossRef] | [PubMed]
Calamia  M;  Markon  K;  Tranel  D:  Scoring higher the second time around: meta-analyses of practice effects in neuropsychological assessment.  Clin Neuropsychol 2012; 26:543–570
[CrossRef] | [PubMed]
Heaton  RK;  Miller  W;  Taylor  MJ  et al:  Revised Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African-American and Caucasian Adults .  Lutz, FL,  Psychological Assessment Resources, 2004
Paradiso  S;  Lamberty  GJ;  Garvey  MJ  et al:  Cognitive impairment in the euthymic phase of chronic unipolar depression.  J Nerv Ment Dis 1997; 185:748–754
[CrossRef] | [PubMed]
Bhardwaj  A;  Wilkinson  P;  Srivastava  C  et al:  Cognitive deficits in euthymic patients with recurrent depression.  J Nerv Ment Dis 2010; 198:513–515
[CrossRef] | [PubMed]
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