Asymmetrical Contribution of Brain Structures to Treatment-Resistant Depression As Illustrated by Effects of Right Subgenual Cingulum Stimulation

Abstract

Major depressive disorder is one of the most common psychiatric disorders, with a worldwide lifetime prevalence rate of 10%-20% in women and a slightly lower rate in men. While many patients are successfully treated using established therapeutic strategies, a significant percentage of patients fail to respond. This report describes the successful recovery of a previously treatment-resistant patient following right unilateral deep brain stimulation of Brodmann's area 25. Current therapeutic approaches to treatment-resistant patients are reviewed in the context of this case with an emphasis on the role of the right and left hemispheres in mediating disease pathogenesis and clinical recovery.

Deep Brain Stimulation for the Treatment of Resistant Depression: Systematic Review of the Literature

“…No alterations were observed in the opposite hemisphere. 61 In a French case report, a patient with long-term MDD and TRD, who had undergone extensive unilateral ECT that led to cognitive deficits, presented with late postoperative seizures as a possible side effect, displayed at standard stimulation parameters (90 µs, 130 Hz, 4.2 V). Most likely, DBS has revealed a previously existing temporal lobe epilepsy, although the participant had no individual or family history of convulsions.…”

“…Considering open-label studies and case reports, the SCg remains promising, although BA 24 is probably the key area underlying the effects. 61 In addition to this, unilateral vs bilateral hemisphere stimulation matters persist. 49 The blind-treatment phase of the RECLAIM ™ trial was probably too short and avoided high stimulation parameters to preserve blinding and prevent AEs.…”

Do Hostile School Environments Promote Social Deviance by Shaping Neural Responses to Social Exclusion?

“…For second‐level processing, we performed a structural region‐of‐interest (ROI) analysis to explore the effects of past HSE exposure on BOLD responses to Exclusion > Inclusion specifically within subACC and, for comparison, dACC. Because laterality in subACC function has been found in past work (Guinjoan et al., ; Teasdale et al., ), right and left subACC (rsubACC, lsubACC) ROIs were created from right and left Brodmann Area (BA) 25 masks as defined by the Talairach‐Tournoux database within AFNI, transformed to MNI space using the tta2mni function, then modified to include only areas of BA 25 that were under the genu of the corpus callosum posterior to y = 30 and identifiable, including through using AFNI's whereami function in MNI space, as “cingulate cortex.” The resultant ROI was similar to significant clusters of activation reported in Cyberball studies on adolescents (C. L. Masten et al., ; C. L. Masten, Eisenberger, et al., ; C. L. Masten, Telzer, & Eisenberger, ; Sebastian et al., ). Right and left dACC (rdACC, ldACC) ROIs were constructed using the “cingulate cortex” mask in the MNI database and modified to use a rostral boundary of y = 32 consistent with criteria established by Vogt, Berger, and Derbyshire () and a caudal boundary of y = 0 given that most social pain studies find activations anterior to that coordinate (see Figure in the online Supporting Information for ROI masks).…”

Recommendations for Deep Brain Stimulation Device Management During a Pandemic

“…If IPG failure is expected to happen, and replacement will not be available, there is no evidence supporting cycling or reduction of stimulation intensity. Alternating stimulation between hemispheres may provide sustained antidepressant response in the subcallosal cingulate, and this could be a potential strategy to slow IPG depletion, but this has not been replicated [29].…”