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Major depression is a mood disorder that affects nearly 7% of the American population and is the most common cause of disability worldwide. Standard treatment typically involves antidepressant medication alone, although a combination of antidepressant medication and psychological treatment, such as psychotherapy or cognitive-behavioral therapy, is often more effective. However, because depression has genetic, environmental, and psychological contributing factors, treatment can be challenging. Approximately 10% of those suffering from depression have treatment-resistant depression (TRD) that does not respond to standard treatment.A number of treatment options for those with TRD target the functioning of the nervous system. Deep-brain stimulation (DBS) , which is used to treat Parkinson disease, has also been investigated as a treatment for TRD. DBS involves implanting a device in the brain that sends electrical impulses to a specific area. Although the mechanism by which DBS alleviates depressive symptoms is unclear, neurostimulation provided by DBS is thought to disrupt dysfunctional patterns of electrical activity in local areas and connected brain regions.A meta-analysis reviewed the data from several studies that used different brain regions as DBS targets in the treatment of TRD. Table 1 shows the percentage of TRD patients who underwent DBS and showed clinical responsiveness and remission of depression. Clinical response was defined as a 50% reduction in scores on a measure of depression. Various scales were used in the studies, including different versions of the Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) . Remission of depression was defined as a score that fell below a predetermined threshold.Table 1 Percentage of TRD Patients Who Showed Clinical Response and Remission With DBS Treatment

-Stimulation of the nucleus accumbens would be expected to alleviate which of the following symptoms of depression?

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Major depression is a mood disorder that affects nearly 7% of the American population and is the most common cause of disability worldwide. Standard treatment typically involves antidepressant medication alone, although a combination of antidepressant medication and psychological treatment, such as psychotherapy or cognitive-behavioral therapy, is often more effective. However, because depression has genetic, environmental, and psychological contributing factors, treatment can be challenging. Approximately 10% of those suffering from depression have treatment-resistant depression (TRD) that does not respond to standard treatment.A number of treatment options for those with TRD target the functioning of the nervous system. Deep-brain stimulation (DBS) , which is used to treat Parkinson disease, has also been investigated as a treatment for TRD. DBS involves implanting a device in the brain that sends electrical impulses to a specific area. Although the mechanism by which DBS alleviates depressive symptoms is unclear, neurostimulation provided by DBS is thought to disrupt dysfunctional patterns of electrical activity in local areas and connected brain regions.A meta-analysis reviewed the data from several studies that used different brain regions as DBS targets in the treatment of TRD. Table 1 shows the percentage of TRD patients who underwent DBS and showed clinical responsiveness and remission of depression. Clinical response was defined as a 50% reduction in scores on a measure of depression. Various scales were used in the studies, including different versions of the Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) . Remission of depression was defined as a score that fell below a predetermined threshold.Table 1 Percentage of TRD Patients Who Showed Clinical Response and Remission With DBS Treatment

-Stimulation of the nucleus accumbens would be expected to alleviate which of the following symptoms of depression?

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11ecba2d_0c73_72ec_a3bf_2f3133064075_MD0008_00 Depression is a mood disorder that is characterized by feelings of sadness, hopelessness, helplessness, low self-worth and self-esteem, fatigue, lack of interest in previously enjoyed activities, loss of motivation, changes in sleep patterns (sleeping more or sleeping less), changes in appetite (eating more or eating less), cognitive difficulties (concentration, decision making, memory), body aches, and lack of pleasure (anhedonia). Those suffering from major depression may also have suicidal ideation or commit suicide. The nucleus accumbens is a structure that is part of the reward pathway in the brain. The reward pathway also includes the ventral tegmental area (which produces dopamine) and portions of the prefrontal cortex. DBS of these structures could help alleviate symptoms of depression, as activation of the reward pathway is associated with feelings of pleasure and the reinforcement of rewarding behaviors. (Choices B, C, and D) Because the nucleus accumbens is part of the reward pathway in the brain, DBS of this area is most likely to impact anhedonia and less likely to impact the cognitive (difficulty concentrating), alertness (fatigue), and sleep (insomnia) symptoms often associated with depression. Educational objective: Depression is a mood disorder characterized by emotional and physical symptoms, such as sadness, hopelessness, anhedonia, difficulty concentrating, fatigue, body aches, and changes in sleep and appetite. Stimulation of the nucleus accumbens in the brain's reward pathway may help alleviate anhedonia, allowing depressed individuals to feel pleasure again.

Passage Major Depression Is a Mood Disorder That Affects Nearly 7