Impact of childhood adversity on deep brain stimulation outcomes for treatment resistant depression

BACKGROUND: The presence of childhood adversity predicts poorer outcome to antidepressant medications and/or psychotherapy. However its impact on neuromodulation outcomes is unclear. We investigated whether adversity affects outcomes in patients receiving Deep Brain Stimulation (DBS) of the subcallosal cingulate area (SCC) for Treatment-Resistant Depression (TRD). METHODS: Longitudinal follow-up data on 56 TRD patients receiving SCC-DBS. The ACE (Adverse Childhood Experiences) questionnaire was used to quantify adversity and estimate its prevalence in these patients. The primary outcome was remission (Hamilton Depression Rating Scale, HAMD-17 ≤ 7). Pre-operative structural MRI metrics were probed for relationships with ACE score. RESULTS: 93% of patients reported experiencing childhood adversity (ACE ≥ 1) and 45% reported ≥4 ACEs (score consistently associated with poor health outcomes). ACE score did not significantly impact rates of remission at 12 or 36 months. There was no differential effect of adversity type (e.g. abuse, neglect, or household dysfunction) on remission. In both high and low ACE score groups, average HAMD-17 scores dropped significantly from baseline to 12 months and remained stable to 36 months. In females, ACE score was negatively correlated with left anterior cingulate cortex surface area, bilateral angular gyrus surface area and left fornix volume, while it was positively correlated with right subiculum volume. CONCLUSIONS: TRD patients receiving SCC-DBS report a high degree of ACEs. There was no deleterious effect of ACEs on antidepressant outcomes with SCC-DBS in the short- or long-term. A history of childhood adversity should not preclude consideration of SCC-DBS for TRD.