Background There is very limited evidence for the efficacy of any specific therapeutic intervention in chronic, treatment refractory major depression. Thermal anterior capsulotomy (ACAPS) is a rarely performed but established therapeutic procedure for this patient group. While benefit has been claimed, previous ACAPS reports have provided limited information. Detailed prospective reporting of therapeutic effects and side effects is required.
Objective To report a prospective study of therapeutic effect, mental status, quality of life, social functioning and neurocognitive functioning in individuals with chronic treatment refractory major depression, treated with ACAPS.
Method A prospective case series of 20 patients treated with ACAPS between 1992 and 1999 were reassessed at a mean follow-up of 7.0±3.4 years. Data were collected preoperatively and at long term follow-up. Structural MRI was performed in 14 participants.
Results According to a priori criteria, at long term follow-up, 50% were classified as ‘responders’ and 40% as ‘remitters’. Fifty-five per cent were classified as ‘improved’; 35% were ‘unchanged’; and 10% had ‘deteriorated’. Neurocognitive and personality testing were not significantly different at follow-up. A trend towards improvement in some aspects of executive neuropsychological functioning was observed. Significant adverse effects were infrequent and there were no deaths.
Conclusions ACAPS may represent an effective intervention for some patients with chronic, disabling, treatment refractory major depression that has failed to respond to other therapeutic approaches. The adverse effect burden within this population was modest, with no evidence of generalised impairment of neurocognitive functioning.
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Funding The study was funded by the Chief Scientist Office of the Scottish Executive Health Department, grant No CZG/2/223. The funding body had no influence on the design of the study, collection or interpretation of the data.
Competing interests KM, DC, RM and MSE provide clinical management for the Dundee Advanced Interventions Service. KM has received research funding from GlaxoSmithKline and Cyberonics Inc, honoraria associated with lecturing and/or travel from Eli Lilly, Wyeth, Medtronic and Bristol Myers Squibb, and has accepted consultancy fees and/or hospitality from Lundbeck and St Jude Medical. MSE has received research funding from Cyberonics Inc and honoraria or travel support from Medtronic and St Jude Medical. DC has received consultancy fees from Servier Laboratories and honoraria for lectures from Wyeth and Lilly. He has received travel from Medtronic and Cyberonics Inc. JDS has received research funding via an honorarium associated with a lecture from Wyeth.
Ethics approval Ethics approval for this study was provided by the Tayside Medical Research Ethics Committee. Written informed consent was obtained from all patients, and as a requirement of the relevant Scottish Mental Health Acts (1984 and 2003), all patients undergoing neurosurgery were independently assessed preoperatively by three panel members from the Mental Welfare Commission for Scotland.
Provenance and peer review Not commissioned; externally peer reviewed.
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