Commentary: Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network

Abstract BACKGROUND Bilateral anterior capsulotomy (BAC) is an effective surgical option for patients with treatment-resistant major depression (TRMD) and treatment-resistant obsessive-compulsive disorder (TROCD). The size of the lesion and its precise dorsal-ventral location within the anterior limb of the internal capsule (ALIC) remain undefined. OBJECTIVE To present a method to identify the trajectories of the associative and limbic white matter pathways within the ALIC for targeting in BAC surgery. METHODS Using high-definition tractography, we prospectively tested the feasibility of this method in 2 patients with TRMD and TROCD to tailor the capsulotomy lesion to their limbic pathway. RESULTS The trajectories of the associative and limbic pathways were identified in the ALIC of both patients and we targeted the limbic pathways by defining the dorsal limit of the lesion in a way to minimize the damage to the associative pathways. The final lesions were smaller than those that have been previously published. This individualized procedure was associated with long-term benefit in both patients. CONCLUSION Tractography-guided capsulotomy is feasible and was associated with long-term benefit in patients with TRMD and TROCD.

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Imipramine in the Treatment of Obsessive-Compulsive Disorder with and without Major Depression

Annals of Clinical Psychiatry ◽

10.3109/10401239109147996 ◽

1991 ◽

Vol 3 (3) ◽

pp. 233-237 ◽

Cited By ~ 4

Author(s):

David Fogelson ◽

Alexander Bystritsky

Keyword(s):

Major Depression ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Komorbidität von Zwangsstörungen und Major Depression: Rolle der HPA-Achse

Fortschritte der Neurologie · Psychiatrie ◽

10.1055/a-0643-4204 ◽

2019 ◽

Vol 87 (12) ◽

pp. 677-678

Keyword(s):

Major Depression ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder

Symptome einer schweren Depression (Major Depression, MD) treten häufig begleitend zu anderen psychiatrischen Erkrankungen wie Zwangsstörungen (Obsessive Compulsive Disorder, OCD) auf. Die hohe Komorbidität zwischen MD und OCD weist auf überlappende Krankheitsmechanismen hin. Für beide Erkrankungen sind Veränderungen in der Hypothalamus-Hypophysen-Nebennierenrinden (HPA)-Achse beschrieben worden.

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Increased serum drug concentrations in concomitant treatment with citalopram, clomipramine and alprazolam

European Psychiatry ◽

10.1017/s0924933800002352 ◽

1994 ◽

Vol 9 (6) ◽

pp. 312-314

Author(s):

U Lepola ◽

E Leinonen ◽

H Koponen

Keyword(s):

Cytochrome P450 ◽

Major Depression ◽

Obsessive Compulsive Disorder ◽

Oxidative Metabolism ◽

Competitive Inhibition ◽

High Serum ◽

Concomitant Treatment ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Drug Concentrations

SummaryWe report the case of a patient with major depression and obsessive-compulsive disorder who had simultaneously high serum citalopram, clomipramine, and alprazolam concentrations probably due to the reciprocal competitive inhibition of the cytochrome P450-catalyzed oxidative metabolism.

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