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Treatment for resistant depression.

Some patients with resistant depression respond to orbitomedial frontal surgical lesions with significant improvement or complete remission, but there have been no reliable indicators of success--and research should address this gap, reported Dr. Per-minder S. Sachdev and Jagdeep Sachdev of the Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia.

Seventy-six consecutive patients at the Prince Henry Hospital were treated with bilateral stereotactic orbitomedial lesions for resistant severe depression between 1973 and 1995. After these patients were followed for a mean of 14 years, nearly 32% (24) of the subjects were dead, with 6 having committed suicide (J. Neuropsychiatry Clin. Neurosci. 2005;17:478-85).

Of the 52 surviving patients, whose mean age was 63 years, 23 underwent in-depth interviews, and lesions were verified in 18 of them by MRI. With a 6-point global outcome rating scale, rated by consensus between two independent psychiatrists, 23% of the subjects were judged to be in remission, and half were judged to be in remission, and half were judged significantly improved, the investigators reported.

The improvement was noted within days or weeks or the surgery, although full recovery could take many months, according to the investigators.

Cognitive impairment was mild; other adverse effects included epilepsy in two subjects, marked personality change in one subject, weight gain in two subjects, and mild personality change in five subjects, the investigators said.
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Title Annotation:care and treatment
Author:Foley, Kevin
Publication:Clinical Psychiatry News
Article Type:Brief article
Geographic Code:8AUST
Date:Feb 1, 2006
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