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Updated: Sep 1, 2025
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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
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Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series
Trevor A Hurwitz1, Christopher R Honey2, Amir Ali Sepehry3
1Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Stereotactic and Functional Neurosurgery
|August 16, 2022
Summary
Bilateral anterior capsulotomy (BAC) is the most effective and safest ablative surgery for treatment-resistant depression (TRD). This finding comes from a systematic review comparing various ablative psychosurgeries.
Area of Science:
- Neurosurgery
- Psychiatry
- Medical Research
Background:
- Ablative lesion procedures are a last resort for refractory depression.
- Current ablative psychosurgeries include bilateral anterior capsulotomy (BAC), bilateral anterior cingulotomy (BACING), and bilateral subcaudate tractotomy (BST).
- Evidence on the optimal surgical target for treatment-resistant depression (TRD) is equivocal due to small cohorts and varying methodologies.
Conclusions:
- Bilateral anterior capsulotomy (BAC) is recommended as the preferred ablative surgical option for treatment-resistant depression.
- Further research with larger, controlled studies is warranted to confirm these findings.
- The safety and efficacy profile of BAC supports its consideration in TRD management.
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