RESUMEN
BACKGROUND: Given the invasiveness of deep brain stimulation (DBS), the effect should prove to be stable over the long-term and translate into an improvement of quality of life (QOL). OBJECTIVE: To study the effectiveness and QOL up to nine years after the DBS surgery. METHODS: We treated 25 adult patients with major depression with DBS of the ventral anterior limb of the internal capsule (vALIC). We followed them up naturalistically for 6-9 years after surgery (mean: 7.7 [SD:1.5] years), including a randomized crossover phase after the first year comparing sham with active DBS. Symptom severity was quantified using the Hamilton Depression Scale with response defined as a ≥50% decrease of the score compared to baseline. Quality of life was measured using the WHOQOL-BREF, assessing 5 domains (general, physical, psychological, social, environmental). RESULTS: Intention-to-treat response rates remained mostly stable from Year 3 to last follow-up (Year 3, 5 and 6: 40%; Year 4: 36%; Last observation: 44%). General, physical, psychological (all P < 0.001) and the environmental (P = 0.02) domain scores increased during DBS optimization and remained stable over the long term. No statistically significant changes were detected on the social domain. Patients scored significantly higher during active than sham DBS on the psychological, social and environmental domains, and trended towards a higher score on the general and physical domains. CONCLUSION: This study shows continued efficacy of vALIC DBS in depression, which translates into an improvement of QOL providing further support for DBS as a durable treatment for TRD.
Asunto(s)
Estimulación Encefálica Profunda , Trastorno Depresivo Resistente al Tratamiento , Adulto , Estimulación Encefálica Profunda/efectos adversos , Depresión/terapia , Trastorno Depresivo Resistente al Tratamiento/terapia , Humanos , Calidad de Vida , Resultado del TratamientoRESUMEN
Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.