Biological basis for the surgical treatment of depression

Abosch, Aviva; Cosgrove, G. Rees

doi:10.3171/foc/2008/25/7/e2

Cited by 42 publications

(20 citation statements)

References 135 publications

(121 reference statements)

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“…It is the leading cause of disability worldwide, as measured by years of life lived with a disability [109]. Some 20% of patients are refractory to the combination of behavioural, pharmacological and electroconvulsive therapy [110]. For these treatment-refractory patients, ablative stereotactic surgery has been proposed in the past, targeting limbic structures of the brain that are involved in the regulation of mood and affect.…”

Section: Refractory Depressionmentioning

confidence: 99%

Deep brain stimulation in Parkinson disease—what went wrong?

Krack

Hariz

2010

Nat Rev Neurol

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Section: Refractory Depressionmentioning

confidence: 99%

Deep brain stimulation in Parkinson disease—what went wrong?

Krack

Hariz

2010

Nat Rev Neurol

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“…The physiological idea behind AC lesions is that interruption of the frontothalamic connections may attenuate negative ruminations that commonly accompany depression (Christensen et al, 2002;Abosch and Cosgrove, 2008), which may be mediated by self-reflective medial fronto-cortical 'resting state' and self-referential networks (Northoff et al, 2006;Northoff, 2010). More specifically, AC may be producing benefit by interrupting the connection between the anterior thalamic nucleus and cingulate gyrusFa component of Papez's limbic circuit that has been implicated in regulating emotionality (MacLean, 1990;Papez, 1995).…”

Section: Discussionmentioning

confidence: 99%

“…ACT is used to treat refractory depression and OCD. The mechanism of therapeutic action remains uncertain, but it is commonly assumed to be due to disruption of one or more components of associated limbicemotional circuitry (Abosch and Cosgrove, 2008;Cho et al, 2008). More recently, studies evaluating the efficacy of ACT in major depression, drug dependence, and pain patients (Steele et al, 2008) suggest that the effects of ACT may be explained on the basis of disconnection of afferent fibers from the midline thalamic nuclei, the function of which is to impart the emotional coloring to perceptions (LeDoux, 1995), especially negative emotions (MacLean, 1990).…”

Section: Discussionmentioning

confidence: 99%

Tractographic Analysis of Historical Lesion Surgery for Depression

Schoene-Bake

Parpaley

Weber

et al. 2010

Neuropsychopharmacol

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Various surgical brain ablation procedures for the treatment of refractory depression were developed in the twentieth century. Most notably, key target sites were (i) the anterior cingulum, (ii) the anterior limb of the internal capsule, and (iii) the subcaudate white matter, which were regarded as effective targets. Long-term symptom remissions were better following lesions of the anterior internal capsule and subcaudate white matter than of the cingulum. It is possible that the observed clinical improvements of these various surgical procedures may reflect shared influences on presently unspecified brain affect-regulating networks. Such possibilities can now be analyzed using modern brain connectivity procedures such as diffusion tensor imaging (DTI) tractography. We determined whether the shared connectivities of the above lesion sites in healthy volunteers might explain the therapeutic effects of the various surgical approaches. Accordingly, modestly sized historical lesions, especially of the anatomical overlap areas, were 'implanted' in brain-MRI scans of 53 healthy subjects. These were entered as seed regions for probabilistic DTI connectivity reconstructions. We analyzed for the shared connectivities of bilateral anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and stereotactic limbic leucotomy (a combination of the last two lesion sites). Shared connectivities between the four surgical approaches mapped onto the most mediobasal aspects of bilateral frontal lobe fibers, including the forceps minor and the anterior thalamic radiations that contacted subgenual cingulate regions. Anatomically, convergence of these shared connectivities may derive from the superolateral branch of the medial forebrain bundle (MFB), a structure that connects these frontal areas to the origin of the mesolimbic dopaminergic 'reward' system in the midbrain ventral tegmental area. Thus, all four surgical anti-depressant approaches may be promoting positive affect by converging influences onto the MFB.

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“…Other arguments express the evolutionary strategy through comparison. For example, the article ''Biological Basis for the Surgical Treatment of Depression'' (Abosch and Cosgrove 2008), advocates for DBS using new models of depression as a systems-level disorder. The article emphasizes the scientific grounding for today's techniques by presenting a litany of improvements in contemporary psychosurgery:…”

Section: Managing the Memory Of Lobotomymentioning

confidence: 99%

A Dark History: Memories of Lobotomy in the New Era of Psychosurgery

Johnson

2009

Medicine Studies

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Deep brain stimulation has recently been identified as the ''new frontier'' in the surgical treatment of major depressive disorder. Powerful memories of the lobotomy era, however, pose a rhetorical challenge to clinical researchers who wish to make a case for its therapeutic future. For DBS advocates, establishing the relationship between these two treatments is not just a matter of telling a history; it also requires crafting persuasive arguments for the lineage of DBS that relate the new psychosurgery in some way to the old. Working from a rhetorical perspective, this article identifies and analyzes three strategies employed by DBS advocates to manage the memory of lobotomy, which it terms evolutionary, genealogical, and semantic. In conclusion, this article suggests that a rhetorical perspective might be brought to bear on the frequent calls for dialogue with regard to psychosurgery, which are meaningless without attention to the persuasive dynamics such dialogue entails.

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Biological basis for the surgical treatment of depression

Cited by 42 publications

References 135 publications

Deep brain stimulation in Parkinson disease—what went wrong?

Deep brain stimulation in Parkinson disease—what went wrong?

Tractographic Analysis of Historical Lesion Surgery for Depression

A Dark History: Memories of Lobotomy in the New Era of Psychosurgery

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