Treatment resistant depression surgery [Neurosurgery Wiki]

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====== Treatment resistant depression surgery ======

First-line treatment includes [[pharmacotherapy]], [[psychotherapy]], and forms of non-invasive brain stimulation such as [[transcranial magnetic stimulation]] and [[electroconvulsive therapy]]. Patients who fail conservative therapy may be candidates for functional neuromodulatory procedures.

Initial attempts at surgical treatment for chronic depression or major depressive disorder (MDD) included nonspecific destructive surgeries such as the prefrontal leucotomy ([[lobotomy]]). After these procedures fell out of favor, more selective ablative procedures targeting the orbitofrontal cortex and the medial prefrontal cortex were attempted. Recently, [[DBS]] targets investigated for treatment of medically intractable depression include: the subcallosal cingulate gyrus, inferior thalamic peduncle, [[nucleus accumbens]], and ventral capsule / [[striatum]].
((Jimenez 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–
93; discussion 585-93))
((Lozano AM, Mayberg HS, Giacobbe P, et al.
Subcallosal cingulate gyrus deep brain stimulation
for treatment-resistant depression. Biol Psychiatry.
2008; 64:461–467))
((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))

Several of these targets gained interest after patients undergoing DBS for [[OCD]] noted improved mood as a side effect
((Nuttin BJ, Gabriels LA, Cosyns PR, et al. Long-term
electrical capsular stimulation in patients with
obsessive-compulsive disorder. Neurosurgery.
2003; 52:1263–72; discussion 1272-4)).
Vagus nerve stimulation (VNS) has also been explored as an option after patients receiving VNS for seizures were noted to have an improvement in depressive symptoms independent of seizure control
((Elger G, Hoppe C, Falkai P, et al. Vagus nerve stimulation
is associated with mood improvements in
epilepsy patients. Epilepsy Res. 2000; 42:203–210))

===== Deep Brain Stimulation =====

see [[Deep Brain Stimulation for depression]].

===== Vagus nerve stimulation =====

see [[Vagus nerve stimulation for depression]].


===== Gamma Knife subcaudate tractotomy for treatment-resistant depression =====
Gamma Knife subcaudate tractotomy for treatment-resistant depression and target characteristics
((Hariz M. Gamma Knife subcaudate tractotomy for treatment-resistant depression 
and target characteristics. Acta Neurochir (Wien). 2016 Nov 8. [Epub ahead of
print] PubMed PMID: 27826803.
)).