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Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression

Published online by Cambridge University Press:  15 December 2016

L. Subramanian ,
T. Bracht ,
P. Jenkins ,
S. Choppin ,
D. E. J. Linden ,
G. Phillips  and
B. A. Simpson
L. Subramanian
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
T. Bracht
Affiliation:
Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
P. Jenkins
Affiliation:
Cyncoed Consulting Rooms, Cardiff, UK
S. Choppin
Affiliation:
Universite Pierre et Marie Curie, Paris, France
D. E. J. Linden*
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine & Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK Cardiff and Vale University Health Board, Cardiff, UK
G. Phillips
Affiliation:
Cardiff and Vale University Health Board, Cardiff, UK
B. A. Simpson
Affiliation:
Cardiff and Vale University Health Board, Cardiff, UK
*
*Address for correspondence: Professor D. E. J. Linden, MD, MRC Centre for Neuropsychiatric Genetics & Genomics; Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK. (Email: lindend@cf.ac.uk)
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Abstract

Background

The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).

Method

This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.

Results

Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.

Conclusions

With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.

Keywords

Anterior capsulotomydepressionmood disorderstereotactic neurosurgerytreatment resistance
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 6 , April 2017 , pp. 1097 - 1106
Copyright
Copyright © Cambridge University Press 2016 

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