Neurosurgical techniques to control and/or treat psychiatric disorders have been controversial since the use of lobotomies in the mid 20th century. A new study in Biol Psychiatry 2008 Apr 1; 63: 670. examines this issue in light of current advances on neurosurgery. This study was reviewed in Journal Watch Psychiatry in the June 2008 Vol. 14 No. 6. Eight patients who had highly difficult to treat depression underwent neurosurgery procedure called cingulotomy which cuts some brain tracts near the anterior cingulated gyrus which is know to be overly active in depressed patients. These patients, prior to surgery, all had long history of depression with repeated failure with antidepressants and ECT. These patients were evaluated one year later to determine their level of recovery which was also correlated with MRI findings. The results showed that one year later some of the patients had significant improvement, “depression remitted in three patients and responded in two.” The MRI findings showed that those patients with more anterior and smaller neurosurgical lesions had a better antidepressant response. For the seriously depressed patient with hard to treat or refractory depression, the question still remains as to whether neurosurgery is an option. The study looked at a small sample of patients, (eight), perhaps too small a sample to come to any meaningful conclusions.
The Bottom Line: Neurosurgery called cingulotomy is being used on seriously ill patients with a long history of repeated failures to antidepressants and ECT. The sample size in this study is very small making it difficult to come to meaningful conclusions the use and appropriateness of neurosurgery for seriously depressed patients.
Dr. Tanya Korkosz
Dr. Jeffrey Speller
Psychopharmacology Associates
of New England
www.psychopharmassociates.com