Effects of Subthalamic Nucleus Deep Brain Stimulation on Depression in Patients with Parkinson’s Disease

Abstract

Objective: In this study, we aimed to investigate the effects of STN-DBS on PD patients with different levels of depression and to identify predictors of the effects of STN-DBS on PD depression. Methods: We retrospectively collected data for 118 patients with PD depression who underwent STN-DBS at Beijing Tiantan Hospital. Neuropsychological, motor, and quality of life assessments were applied preoperatively and postoperatively. All patients were divided into two groups according to their HAM-D24 total scores (group Ⅰ: mild depression; group Ⅱ: moderate depression). A mixed repeated-measure analysis of variance (ANOVA) was performed to investigate whether there were differences in depression scores before and after STN-DBS between the two groups. The changes in depression scores were also compared between groups using ANCOVA, adjusting for gender and preoperative HAMA scores. Logistic regression was performed to identify predictors of STN-DBS’s effects on PD depression. Results: Both groups showed significant improvement in depression symptoms after STN-DBS. Compared with patients in group Ⅰ, patients in group Ⅱ showed greater reductions in their HAM-D24 total scores (p = 0.002) and in HAM-D24 subitems including cognitive disturbances (p = 0.026) and hopelessness symptoms (p = 0.018). Logistic regression indicated that gender (female) (p = 0.014) and preoperative moderate depression (p < 0.001) patients had greater improvements in depression after STN-DBS. Conclusions: Patients with moderate depression showed better improvement than patients with mild depression. Gender (female) and preoperative HAMA scores are predictors of STN-DBS’s effects on PD depression.

Gender discrepancies and differences in motor and non-motor symptoms, cognition, and psychological outcomes in the treatment of Parkinson’s disease with subthalamic deep brain stimulation

“…Although depressive symptoms appeared to decrease more in women than in men, further analysis showed significant modulation by gender, but not for STN-DBS time or the interaction between STN-DBS time and gender ( 27 ). Importantly, this and other studies consistently reported that women had more severe depressive symptoms than men before surgery ( 24 , 27 , 32 , 41 ). In general, most other studies showed equal improvement in depression in both genders ( 24 , 25 , 32 , 42 ).…”

“…In general, women seem to outperform men in cognitive tests (13), but this does not necessarily explain a possible gender-specific difference in improvement after STN-DBS. Prior to surgery, women exhibit more severe depressive symptoms (24,27,32,41), which is also observed in the general PD population (13). However, there is evidence of general improvement of depression in both genders after STN-DBS (24,32).…”

“…Regarding depression, a total of seven studies were reviewed ( 24–27 , 32 , 41 , 42 ), with one study reporting greater improvement in depression in female patients ( 41 ) and one study reporting greater improvement in depression in male patients after STN-DBS ( 26 ). Furthermore, a longitudinal study reported that women had more depressive symptoms in all phases of STN-DBS surgery and LEDD was positively correlated with depressive symptoms only in women ( 27 ).…”

Premature drug reduction after subthalamic nucleus deep brain stimulation leading to worse depression in patients with Parkinson's disease

“…This will result in a greater number of test parameters being combined. Furthermore, while real-time observation and adjustment of stimulation parameters and contacts can improve motor symptoms, most non-motor symptoms cannot be effectively adjusted through real-time observation ( 13 , 14 ). As a result, the curative effect of programming is highly dependent on the programming doctor's experience and the number of times the patient has gone through trial and error.…”