Application And Exclusion Criteria For The Screening And Preoperative Evaluation Phases

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The authors not only provided a longitudinal data that demonstrated safety of SCC DBS for patients with MDD and BP, but also introduced DBS as an antidepressant intervention for patients with BP. However, further changes and clarifications are needed for efficacy measurements and parameter adjustments for changing the currents of stimulation and for reporting results. While this study has potentially profound clinical implications, the authors should resubmit the study with changes before being accepted in the publication. The inclusion and exclusion criteria for the screening and preoperative evaluation phase were well-defined as shown in Fig. 1. The authors defined TRD patients as patients who were not adequately responding at least four antidepressant interventions and scoring at least three on the Antidepressant Treatment History Form (Sackeim, 2001). This guideline to define TRD is comparable to other controlled trials in similar experiments (i.e. DBS for patients with TRD) (Fava, 2003). Also, the authors accounted for potential confounding variables by excluding all patients who showed contraindications for DBS surgery and its active stimulation. The authors had a nice balance of patients between MDD (n =10) and BP (n=7) prepared for SCC DBS surgery. However, the following revisions on parameter adjustments are recommended to improve the paper. All patients initially received 130-Hz, 91-µs pulse, and 4-mA (mA) current during the initial active

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