Ventral capsule/ventral striatum deep brain stimulation versus anterior capsulotomy in treatment-resistant major...

Ventral capsule/ventral striatum deep brain stimulation (VC/VS-DBS) for treatment-resistant depression (TRD) has shown promising results. Despite its efficacy, DBS is costly and less accessible, while anterior capsulotomy (ACAPS), though permanent and non-adjustable, offers clinical advantages.

A systematic review and data analysis were conducted to evaluate articles reporting on clinical outcomes and adverse effects of VC/VS-DBS and ACAPS for TRD. A quality assessment of the included studies was performed to determine homogeneity across reports. To assess the intervention's efficacy, changes in pre- and post-intervention scores on the Hamilton Depression Rating Scale (HRSD-17) were analyzed.

Seven studies with 138 TRD patients were analyzed. Among 75 ACAPS patients, mean pre-operative HRSD-17 scores decreased by 46 %, from 26.97 ± 3.12-14.53 ± 1.15, with an improvement of 11.87 points (95 % CI: 8.83-14.91). For 63 VC/VS-DBS patients, scores declined by 42 %, from 27.5 ± 4.13-15.93 ± 5.13, corresponding to an improvement of 9.68 points (95 % CI: 5.08-14.27). Adverse effects included suicidal ideation (7 %) and hypomania (3.6 %) with DBS, while ACAPS was associated with headaches and long-term effects like reduced motivation and weight gain in 15-20 % of patients.

Both VC/VS-DBS and ACAPS show efficacy in treating TRD, with ACAPS showing slightly better outcomes and no significant adverse effects reported. However, given study heterogeneity, a robust, well-powered randomized controlled trial is essential to more precisely compare these techniques and clarify their clinical impact on TRD.