Background: There is an urgent need to develop safe and effective treatments for patients with treatment-resistant depression (TRD). Several neurosurgical procedu

/pdf/the-history-and-future-of-ablative-neurosurgery-for-major-4238s90bys.pdf

The History and Future of Ablative Neurosurgery for Major Depressive Disorder

SummaryIn this report, recommendations for the pharmacological treatment of anxiety and obsessive-compulsive disorders are presented, based on available randomized, placebo-or comparator-controlled

/pdf/world-federation-of-societies-of-biological-psychiatry-wfsbp-4hulj8ttls.pdf

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

https://koenigslab.psychiatry.wisc.edu/pdfs/Koenigs%20&%20Grafman%20BBR%20depression%20review.pdf

The functional neuroanatomy of depression: Distinct roles for ventromedial and dorsolateral prefrontal cortex

Toward DSM-V: basic nomenclature issues. Proposed basic and clinical neuroscience research agenda to guide the development of a pathophysiologically-based classification. Report from developmental issues and diagnosis work group. A research agenda for addressing crucial gaps in the DSM: personality disorders and relational disorders. Mental disorders and disability: time to reevaluate the relationship? Beyond the funhouse mirrors: research agenda on culture and psychiatric diagnosis

A Research Agenda for DSM-V

Serotonin in aging, late-life depression, and alzheimer's disease : The emerging role of functional imaging

BACKGROUND Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.

METHOD Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.

RESULTS SST allows 40-60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% post-operatively, from 15% in cases of uncontrolled affective disorders is seen.

CONCLUSION As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.

Psychosurgery: stereotactic subcaudate tractomy. An indispensable treatment.

The outcome of all psychosurgical operations (stereotactic subcaudate tractotomies) performed at the Geoffrey Knight National Unit for Affective Disorders in London since 1979 is reviewed. Of patients who had suffered severe mood or obsessive-compulsive disorders before surgery, 84 of 249 (34%) were well 1 year after. The effects of gender, psychiatric diagnosis, and age on outcome are assessed. The findings are compared with a 1975 outcome study, and explanations for apparent differences are proposed.

Psychosurgical Operation of Stereotactic Subcaudate Tractotomy, 1979-1991

The initial period of enthusiasm for the surgical treatment of certain psychiatric illnesses, has later given way to increasing rejection of this mode of therapy. But more recently there has been a reappraisal of the therapeutic possibilities of the modern refined operations, which are now receiving more objective assessment.

Contemporary indications for psychosurgery.

Aspartic acid, 5-hydroxyindoleacetic acid, glutamic acid, homovanillic acid and 3-methoxy-4-hydroxyphenylethylene glycol was determined in samples of ventricular fluid from 82 subjects. Laminar distribution of the total number (Bmax value) of serotonin 1A receptors was determined on seven neurosurgical samples of neocortex. Apart from an association in a small subgroup of subjects between homovanillate concentration and corticosteroid medication, no complicating influences of treatment preceding operation were found. The content of the serotonin metabolite alone was significantly reduced in intractable depressive illness (bipolar and major depressive disorders) compared with neurological conditions subdivided into Alzheimer's disease, other dementias and other conditions. There was no other significant difference between these groups for the compounds measured. The total number of serotonin 1A receptors was highest in the superficial layers, being considerably higher than in the rat, irrespective of cortical layer. This part of the study indicated that these receptors are important for regulating activity of human corticocortical glutamatergic neurons. The results are discussed in relation to treating depression with serotonergic agents and targeting corticocortical glutamatergic neurons as well as acetylcholine in Alzheimer's disease.

https://jnnp.bmj.com/content/jnnp/56/1/80.full.pdf

Antemortem measurements of neurotransmission: possible implications for pharmacotherapy of Alzheimer's disease and depression.

The results of stereotactic subcaudate tractotomy in nine patients with resistant bipolar affective disorder are presented in the form of a single case study with a summary of the other eight cases. Follow-up studies at 2-4 years showed substantial improvement in five patients and amelioration of symptoms in a further four patients, with a tendency for a greater improvement in the manic than in the depressive episodes. These preliminary results suggest that there is a place for this operation in the management of severe bipolar affective disorders which are not responding to any other treatment, although decisive recovery occurs less often than with unipolar depression.

J R Bartlett

Papers

Psychosurgery: stereotactic subcaudate tractomy. An indispensable treatment.

Psychosurgical Operation of Stereotactic Subcaudate Tractotomy, 1979-1991

Contemporary indications for psychosurgery.

Antemortem measurements of neurotransmission: possible implications for pharmacotherapy of Alzheimer's disease and depression.

Resistant bipolar affective disorder treated by stereotactic subcaudate tractotomy.