Related Experiment Video
Updated: Jan 1, 2026
Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Long versus short pulse width subcallosal cingulate stimulation for treatment-resistant depression: a randomised,
Rajamannar Ramasubbu1, Darren L Clark2, Sandra Golding2
1Departments of Psychiatry and Clinical Neurosciences, Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Foothills Hospital, Calgary, AB, Canada.
Short and long pulse width deep brain stimulation (DBS) for treatment-resistant depression showed similar efficacy and safety. Both stimulation types effectively reduced depressive symptoms, indicating a role for parameter titration in optimizing outcomes.
Area of Science:
- Neuroscience
- Psychiatry
- Neurosurgery
Background:
- Deep brain stimulation (DBS) requires optimized parameters for treatment-resistant depression (TRD).
- Controlled data on ideal stimulation parameters for DBS in depression are limited.
- This study investigated the efficacy and safety of short pulse width (SPW) and long pulse width (LPW) subcallosal cingulate DBS.
Purpose of the Study:
- To establish the efficacy and safety of SPW and LPW subcallosal cingulate DBS in patients with treatment-resistant depression.
- To compare the outcomes of SPW versus LPW stimulation in reducing depressive symptoms.
- To explore the role of stimulation parameter titration in optimizing DBS therapy for depression.
Main Methods:
- A double-blind, randomized, crossover trial was conducted with 22 patients diagnosed with major depressive disorder or bipolar depression.
- Patients received bilateral DBS implantation in the subcallosal cingulate white matter.
- Participants were randomly assigned to either SPW (90 μs) or LPW (210-450 μs) stimulation for 6 months, followed by a crossover period if initial treatment was ineffective. The Hamilton Depression Rating Scale (HDRS) was used for outcome assessment.
Main Results:
- A significant reduction in HDRS scores was observed at 6 months (p<0.0001) with no significant difference between SPW and LPW groups (p=0.54).
- The crossover phase did not yield significant improvements within or between groups from 6 to 12 months.
- Adverse events were comparable between groups, with worsening anxiety and depression being the most common psychological adverse events.
Conclusions:
- Both LPW and SPW subcallosal cingulate DBS demonstrated similar efficacy and safety profiles in reducing depressive symptoms.
- These findings suggest that both pulse width and amplitude titration are important for optimizing clinical outcomes in patients with treatment-resistant depression.
- Subcallosal cingulate DBS is a viable option for managing treatment-resistant depression, with flexibility in parameter selection.
