Cardiovascular Autonomic and Circadian Aspects of Bilateral Stimulation of Brodmann´s Area 25 in a Patient With Treatment-Refractory Depression

SALVADOR M. GUINJOAN; ELSA COSTANZO; DANIEL E. VIGO; SANTIAGO PÉREZ LLORET; MARCELO MERELLO; EDUARDO TENCA; JULIO ANTICO; DANIEL CERQUETTI; RAMÓN LEIGUARDA; MARTÍN NOGUÉS; ÁNGEL CAMMAROTTA; DANIEL CARDINALI

Washington DC

Congreso; American Psychiatric Association 161th Annual Meeting; 2008

American Psychiatric Association

We performed bilateral deep-brain stimulation of subcallosal cingulus white matter (i.e. associated to Brodmann´s Area 25) (Cg25WM-DBS) in a 63 year old male with treatment-resistant depressive disorder after obtaining informed consent and approval from the local ethics and national government authorities. Patient had failed to respond to multiple drug trials and a course of 15 ECT sessions. Concomitant medication included venlafaxine 225 mg po qd and quetiapine 200 mg po bid.  DBS-BA25 brought about an improvement in depressive symptoms within the first week of the procedure, which is maintained a month afterwards. We observed a significant effect of treatment on heart rate variability (HRV) parameters indicative of autonomic input to the heart (F=8.83, p=0.004), such that parasympathetic activity (% high-frequency HRV) was higher (43 ± 9 vs 27 ± 9 at 0800; 53 ± 4 vs 23 ± 10 at 1200) and sympathetic output (% low-frequency HRV) was lower (57 ± 7 vs 73 ± 9 at 0800; 53 ± 4 vs 77 ± 10 at 1200) in morning hours. COSINOR analysis confirmed a 12-h phase shift of sympatho-vagal rhythm associated to Cg25WM-DBS (acrophase 0100 h during treatment, F=3.82, p=0.04 vs. acrophase 1100h at baseline, F=4.65, p=0.008). Stimulation of most proximal electrodes unexpectedly resulted in severe orthostatic hypotension unresponsive to usual measures, which reversed immediately after resetting stimulation parameters. If replicated in other patients, the present results suggest that Cg25WM-DBS may due its beneficial effect in part to resetting of circadian and autonomic bodily feedback onto the central nervous system.