D. Puigdemont

P.2.b.021 Amygdala shape differences in patients with major depressive disorder

M. Serra-Blasco1 °, J. De Diego-Adelino1, D. Puigdemont1, Y. Vives-Gilabert2, A. Santos3, I. Crespo3, A. Martin-Blanco1, E. Alvarez1, V. Perez1, M.J. Portella1 1Institut d’Investigacio Biomedica Sant Pau (IIB Sant Pau) Universitat Autonoma de Barceona (UAB) Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Department of Psychiatry, Barcelona, Spain; 2INNDACYT, Department of Medical Imaging, Barcelona, Spain; 3Hospital de la Santa Creu i Sant Pau Universitat Autonoma de Barcelona (UAB) Institut d’Investigacio Biomedica Sant Pau (IIB Sant Pau) Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Department of Endocrinology, Barcelona, Spa

P.2.b.013 Does the early response to deep brain stimulation in depression represent a placebo or electrode insertion effect

6 INTRODUCTION Deep Brain Stimulation (DBS) in the subgenual cingulated (Cg25) has revealed as a new and promising innovative technique that may be able to provide sustained remission in resistant major depressive disorder. The first clinical series have reported an initial large effect followed by a decay in the first month of treatment. However, this unexpected phenomenon, attributed to a potential placebo effect or a physiological response to probe insertion, remains poorly understood.

P.2.g.009 Early antidepressant response of deep brain stimulation for depression treatment: a translational study

provide sustained remission in resistant major depressive disorder. However, the first clinical series have reported an initial large effect followed by a decay in the first month of treatment . Thus, the aim of this study was to examine the effect of the electrical brain stimulation and the electrodes implantation in a traslational study. Perez-Caballero L, Pérez-Egea R, Puigdemont D, Molet J, Micó JA, Pérez V, Berrocoso E

P01-84 - Deep brain stimulation, electroconvulsive therapy, or both? A two case report

Background Electroconvulsive therapy (ECT) cannot always be effective for Treatment Resistant Depression. Deep brain stimulation (DBS), a procedure that involves the direct implantation of stimulation electrodes in localized brain regions with the aim of modulating local and connected abnormal activity, has recently been gaining momentum as an alternative treatment modality for the most severe TRD patients. However, there is minimal experience with ECT in patients who have undergone DBS procedures. Methods We present two cases of patients who remitted from TRD after SCG-DBS, and some months after they suffered a relapse that was treated with ECT. Results Before DBS intervention, ECT was not capable to sustain response more than two weeks beyond and was even bad tolerated by these patients. DBS was effective for both patients until a severe relapse occurred (after 4 and 14 months, respectively). Optimization of medication did not elicit response, given the seriousness of symptoms and their previous treatment resistance. Therefore, neurostimulator was turned off in order to administer ECT to both patients. After usual series of sessions set at corresponding parameters over 3 weeks, using bitemporal electrode placement, the episode remitted. Deep brain stimulator was turned on again, and they were in remission until the present moment. Conclusions The use of ECT proved to be effective without adverse effects to the patients or to the DBS hardware. The modulation of SCG activity and its downstream targets might also serve as a trigger for the therapeutic effect of formerly useful or even never-effective antidepressant strategies.

FC01-03 - Deep brain stimulation of subcallosal cingulate gyrus for treatment resistant depression

Background Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) has been suggested to improve depressive symptoms in treatment-resistant depression (TRD). We now report preliminary results of DBS and one-year follow up in six patients. Methods Six patients with severe TRD (Thase Resistance Index>4) underwent DBS surgery and subsequent monthly assessments. DBS response was defined as ≥50% reduction in the 17-item Hamilton Depression Rating Scale (HDRS) or HDRS Results DBS led to early and late reductions of average HDRS (from 22.5 to 9.8 and 6.25 respectively, see Figure 1 for evolution of HDRS mean scores). One month after surgery 16.7% of patients met criteria for response and for remission. Three months after response rates increased to 66.7% while remission rates were maintained. At six months, 66.7% of patients were responders. After 9 months, response rates arose up to 83.4% and these rates were largely maintained at 12 months. Remission rates showed similar growth over follow-up. No substantial differences were observed in electrodes location, and they were not found to be related to response or remission rates. The number of serious adverse effects was small with no patient experiencing permanent deficits. Conclusions This study suggests that DBS is relatively safe and provides significant improvement in patients with TRD. Improvement on average seems to be linearly progressive and, once melioration is achieved, it is maintained for at least one year. The procedure is well tolerated.