80 Chapter 4 psychiatric comorbidities (n = 54). These comorbidities were diagnosed as: MDD (n = 33), OCD (n = 19), anxiety/generalised anxiety disorder (GAD) (n = 11), post-traumatic stress disorder (PTSD) (n = 10), panic disorder (n = 3), borderline personality disorder (BPD) (n = 3), personality disorder not otherwise specified (PD-NOS) (n = 2), and substance use disorder (n = 2). Supplementary table 1 shows all study and patients characteristics. At time of surgery, eight participants were not taking medication, six used one drug and 42 used two drugs or more. The types of drugs consisted of SSRIs (selective and non-selective), benzodiazepine agonists, atypical antipsychotics, antiepileptics, and tetracyclic antidepressants. No major psychopharmacological adjustments were made during the follow-up. 32 out of 56 participants received DBS to the NAcc, 20 patients received DBS to the SCC, and 4 to the vALIC. Three of the studies (4, 15, 33) used either the SCC, NAcc, or the vALIC as the DBS target, while the fourth study (25) used either the SCC or NAcc for their patients, based on their primary comorbidity. 4 out of 8 participants received DBS to the SCC, and 4 to the NAcc in the last mentioned study. Overall, 3 out of 56 participants had their electrodes explanted before the end of follow-up (4, 33, 34). Main analyses: effects on BMI Random effects meta-analysis showed a significant increasing effect of DBS on primary outcome BMI change after DBS, with a large effect size (Hedges’s g = 1 ∙ 13; 95% CI = 0 ∙ 80 to 1 ∙ 46; Z-value = 6 ∙ 75; P < 0 ∙ 001, figure 2), without heterogeneity (I2 = 0 ∙ 00, P = 0 ∙ 901) (Figure 2). Secondary analysis: effects on psychiatric symptom domains DBS also had a beneficial effect on secondary outcome combined psychiatric symptom severity at last observation (Hedges’s g = 0 ∙ 89; 95% CI = 0 ∙ 57 to 1 ∙ 21; Z-value = 5 ∙ 47; P < 0 ∙ 001, I2 = 4 ∙ 29, P = 0 ∙ 371, Supplementary Fig. 2). Eating disorder symptoms Three non-randomized non-controlled clinical trials (15, 25, 33) assessed eating disorder symptoms. Random effects analyses showed a beneficial main effect of 0 ∙ 98 (Hedges’s g; 95% CI = 0 ∙ 28 to 1 ∙ 68; Z-value = 2 ∙ 74; P = 0 ∙ 006; Supplementary figure 3). Symptoms of depression All studies assessed symptoms related to depression. Random effects analyses showed a beneficial main effect of 0 ∙ 98 (Hedges’s g; 95% CI = 0 ∙ 54 to 1 ∙ 41; Z-value = 4 ∙ 43; P = 0 ∙ 00; Supplementary figure 4).
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