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Long-Term Outcome of Neurosurgery for the Treatment of Resistant Depression

Received October 12, 2003; revised May 26, 2004; accepted June 24, 2004. From the School of Psychiatry, University of New South Wales; Neuropsychiatric Institute, Prince of Wales Hospital; South-Eastern Sydney Area Health Service, Randwick NSW 2031, Australia. Address correspondence to Professor Perminder S Sachdev, Neuropsychiatric Institute, Prince of Wales Hospital, Barker St., Randwick NSW 2031, Australia; p.sachdev{at}unsw.edu.au (E-mail).

Between 1973 and 1995, a total of 76 patients were treated with bilateral stereotactic, orbitomedial lesions for resistant severe depression at the Neuropsychiatric Institute, Sydney, Australia. On follow up after a mean 14.4 years, 24 (31.6%) subjects were confirmed dead, with six having committed suicide. Of the 52 patients still alive (mean age 62.9 years), 23 were interviewed in detail, and lesions verified in 18 with magnetic resonance imaging (MRI). On a 6-point global outcome rating scale, rated by consensus between two independent psychiatrists, five (22.7%) were judged to be completely recovered and another 11 (50%) showed significant improvement. The improvement was noted within days or weeks of the surgery. Adverse effects were epilepsy (2 subjects), marked personality change (1), weight gain (2), and mild personality change (5). Any reported cognitive impairment was mild. No definite predictors of improvement were identified.

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