J Neuropsychiatry Clin Neurosci 1997; 9:259-266
Copyright © 1997 by American Neuropsychiatric Association
Clinical, motor, and biological correlates of depressive disorders after focal subcortical lesions
EC Lauterbach, JG Jackson, ST Price, AN Wilson, AD Kirsh and GE Dever
Department of Psychiatry and Behavioral Sciences, Mercer University School of Medicine, Macon, Georgia 31207-0001, USA.
The authors studied depression after focal subcortical lesions (SCLs) in 45
highly selected subjects. Secondary major depression (secondary MD)
occurred in 20.0%, depressive disorder NOS (secondary DDNOS) in 4.4%, and
secondary dysthymia in 0.0%. secondary MD after SCLs was associated with
pallidal lesions (88.9%) and dystonia without geste antagonistique;
subjects with secondary DDNOS had nigrotegmental lesions and parkinsonism.
Depressive severity after SCLs correlated positively with severity of
parkinsonism and dystonia. Pallidal lesions disrupting neurotransmitter
systems and pallidothalamic and parietal input to the frontal lobe may lead
to secondary MD, whereas nigrotegmental lesions may predispose to secondary
MD forme fruste (secondary DDNOS) through disruption of mesocortical
frontal or nigrostriatal dopamine tracts. Patients should be closely
followed over several years for depression after such lesions, especially
when accompanied by parkinsonism or dystonia without geste antagonistique.
