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Research Supports Surgery for Refractory Depression

Evidence suggests a biological basis for surgical interventions such as deep brain simulation

MONDAY, July 7 (HealthDay News) -- Mounting evidence suggests that depression is a network disorder instead of a condition related to perturbation of a single neurotransmitter or brain region, suggesting that surgical interventions such as deep brain stimulation may benefit selected patients with refractory depression, according to two studies published in the July issue of Neurosurgical Focus.

In one study, Aviva Abosch, M.D., of the University of Minnesota Medical School in Minneapolis, and colleagues reviewed recent clinical and imaging data, current disease models, case reports and patient series to assess the biological basis for the surgical treatment of refractory depression. They concluded that appropriate clinical trials of deep brain stimulation in combination with neuroimaging -- and the development of better animal models for depression -- would lead to a better understanding of depression and the potential for surgical interventions.

In a second study, Jason S. Hauptman, M.D., of the University of California Los Angeles, and colleagues conducted a comprehensive literature review of deep brain stimulation studies. They identified three brain areas that have already been safely and effectively targeted in humans -- ventral striatum/nucleus accumbens, subgenual cingulate cortex (area 25), and inferior thalamic peduncle -- and two others that have not yet been targeted: rostral cingulate cortex (area 24a), and lateral habenula.

"This is a critical and exciting time for the functional neurosurgeon," Hauptman and colleagues conclude. "Modern neuromodulation now offers hope to many people who may regain the capacity for normal social interaction and eventually return to work. Beyond the negative history of psychosurgery, we have the opportunity to advance and broaden the spectrum of deep brain stimulation applications. A solid scientific rationale, a flawless experimental protocol, and an adherence to a strong code of ethics are vital to ensuring the success of these endeavors."

Abstract - Abosch
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Abstract - Hauptman
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