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. 2021 Aug 10;46(4):E490-E499.
doi: 10.1503/jpn.210028. Epub 2021 Jul 1.

Personality changes with subcallosal cingulate deep brain stimulation in patients with treatment-resistant depression

Rajamannar Ramasubbu  1 , Laina McAusland  2 , Sanchit Chopra  2 , Darren L Clark  2 , Bettina H Bewernick  2 , Zelma H T Kiss  2
Affiliations

Personality changes with subcallosal cingulate deep brain stimulation in patients with treatment-resistant depression

Rajamannar Ramasubbu et al. J Psychiatry Neurosci. .

Abstract

Background: Deep brain stimulation (DBS) is a promising investigational approach for treatment-resistant depression. However, reports suggesting changes in personality with DBS for movement disorders have raised clinical and ethical concerns. We prospectively examined changes in personality dimensions and antidepressant response to subcallosal cingulate (SCC)-DBS for treatment-resistant depression.

Methods: Twenty-two patients with treatment-resistant depression underwent SCC-DBS. We used the NEO Five-Factor Inventory for personality assessment at baseline and every 3 months until 15 months post-DBS. We assessed depression severity monthly using the Hamilton Depression Rating Scale.

Results: We found a significant decrease in neuroticism (p = 0.002) and an increase in extraversion (p = 0.001) over time, showing a change toward normative data. Improvement on the Hamilton Depression Rating Scale was correlated with decreases in neuroticism at 6 months (p = 0.001) and 12 months (p < 0.001), and with an increase in extraversion at 12 months (p = 0.01). Changes on the Hamilton Depression Rating Scale over time had a significant covariate effect on neuroticism (p < 0.001) and extraversion (p = 0.001). Baseline openness and agreeableness predicted response to DBS at 6 (p = 0.006) and 12 months (p = 0.004), respectively.

Limitations: Limitations included a small sample size, a lack of sham control and the use of subjective personality evaluation.

Conclusion: We observed positive personality changes following SCC-DBS, with reduced neuroticism and increased extraversion related to clinical improvement in depression, suggesting a state effect. As well, pretreatment levels of openness and agreeableness may have predicted subsequent response to DBS. The NEO Five-Factor Inventory assessment may have a role in clinical decision-making and prognostic evaluation in patients with treatment-resistant depression who undergo SCC-DBS.

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Conflict of interest statement

Competing interests: R. Ramasubbu has received honoraria for serving on advisory committees for Astra Zeneca, Lundbeck, Janssen and Otsuka. He also received investigator-initiated grants from Astra Zeneca and Pfizer. No other competing interests declared. Z. Kiss has received grants from the Natural Sciences and Engineering Research Council of Canada and the Dystonia Medical Research Foundation of Canada Foundation for Innovation, as well as honoraria from Elsevier, all unrelated to the present work. No other competing interests declared.

Figures

Figure 1
Figure 1
Personality dimensions at baseline compared to normative data. Patients with treatment-resistant depression (n = 21) compared to the healthy normative sample (mean ± standard deviation) on 5 personality dimensions. Grey shaded area represents published normative data. ***p < 0.001 and clinically meaningful (> 1 standard deviation; 1 standard deviation = 10 points on the scale); **p < 0.01. Neuroticism Extraversion Openness Agreeableness Conscientiousness
Figure 2
Figure 2
Personality changes over time. (A) Changes in raw personality scores from baseline to 15 months after deep brain stimulation. Baseline scores denote the significance of omnibus test results, and scores at specific time points denote the significance of post hoc test results. ***p < 0.001; **p < 0.01. (B) Changes in personality t scores; grey shaded area represents the range of the normative data.
Figure 3
Figure 3
Correlation between depression scores and personality dimensions. (A) Correlation analysis for change in depression (Hamilton Depression Rating Scale) and neuroticism from 0 to 6 months. (B) Correlation analysis for change in depression and neuroticism from 0 to 12 months. (C) Correlation analysis for change in depression and extraversion from 0 to 12 months. (D) Correlation analysis for change in agreeableness from 0 to 12 months.
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