Tiefe Hirnstimulation bei therapieresistenter Depression

Zusammenfassung

Ein Drittel der an einer Depression erkrankten Patienten leidet nach der Behandlung mit etablierten Therapieverfahren wie Pharmakotherapie und Psychotherapie weiterhin an erheblichen Restsymptomen. Diese therapieresistente Depression (TRD) verursacht oft große Einschränkungen in allen Lebensbereichen und in der Lebensqualität. Neue Hirnstimulationsmethoden wie die Tiefe Hirnstimulation (THS) bei TRD zeigen in unterschiedlichen Zielregionen im Gehirn übereinstimmend eine positive antidepressive Wirksamkeit. Die heutzutage am meisten beforschten Zielregionen bei der THS für TRD Pa­tienten sind die Capsula interna, der subgenuale zinguläre Kortex (Brodman Areal, Cg25), der Nukleus accumbens und der supero-laterale Bereich des medialen Vorderhirnbündels (supero-lateral branch of the medial forebrain bundle, slMFB). Die Anhedonie als Kernsymptom der Depression wird wohl am besten beeinflusst durch die Stimulation im Nukleus accumbens und im slMFB. Der schnellste und beste antidepressive Effekt wird durch die Stimulation im slMFB gezeigt mit einer Responserate von 85% innerhalb weniger Tage.

Abstract

About 30% of depressed patients still suffer from considerable residual symptoms despite treatment with established therapies such as antidepressants and psychotherapy. These treatment-resistant depressed (TRD) patients often have ­severe limitations in their quality of life. New brain stimulation techniques such as deep brain stimulation (DBS) in TRD show in different targets in the brain consistently a positive antidepressant efficacy. Nowadays, the most researched targets of DBS for TRD patients are the internal capsule interna, the subgenuale cingulate cortex (Brodman area, Cg25), the nucleus accumbens and the supero-lateral area of the medial forebrain bundle (supero-lateral branch of the medial forebrain bundle, slMFB). Anhedonia as a core symptom of depression is believed to be most affected by the stimulation of the nucleus accumbens and the slMFB. The fastest and most significant antidepressant effects are shown by the stimulation in the slMFB with a response rate of 85% within a few days.

Schlüsselwörter

Tiefe Hirnstimulation - Therapieresistente Depression - antidepressiver Effekt - Anhedonie - Capsula interna - subgenuale zinguläre Kortex - Nukleus accumbens - supero-lateraler Bereich des medialen Vorderhirnbündels

Key words

deep brain stimulation - therapy-resistant depression - antidepressive effect - anhedonia - capsule interna - subgenuale cingulate cortex - nucleus accumbens - supero-lateral branch of the medial forebrain bundle

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