Deep Brain Stimulation for Depression

Deep brain stimulation, an experimental and invasive treatment that involves stimulating the brain with electrical signals, may help treat otherwise difficult to cure depression, a new study reports.

Depression is an illness that involves the body, mood and thoughts. Imbalances in three brain chemicals, serotonin, norepinephrine and dopamine, are linked to depression. Unlike normal emotional experiences of sadness, loss or passing mood states, depressive disorders are persistent and can significantly interfere with an individual's thoughts, behavior, mood, activity and physical health.

Depressive disorders affect approximately 18.8 million American adults or about 9.5 percent of the U.S. population age 18 and older in a given year. Among all medical illnesses, major depression is the leading cause of disability in the United States and many other developed countries. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help most people who suffer from depression.

Researchers from the University of Toronto, Toronto, Canada, explained that an early report in six patients suggested that deep brain stimulation of the subcallosal cingulate gyrus (part of the brain) may provide benefit in treatment-resistant depression.

In the study, 20 patients with treatment-resistant depression underwent serial assessments before and after the deep brain stimulation. The researchers analyzed the percentage of patients who achieved a response or remission after surgery. They also examined changes in brain metabolism associated with deep brain stimulation.

The researchers observed both early and progressive benefits with deep brain stimulation. For example, one month after surgery, 35 percent of the patients met criteria for response with 10 percent of patients in remission. Furthermore, six months after surgery, 60 percent of patients were responded to therapy and 35 percent met the criteria for remission. These benefits were largely maintained at 12 months.

Deep brain stimulation therapy was associated with specific changes in the metabolic activity localized to cortical and limbic circuits implicated in the pathogenesis of depression. The number of serious adverse effects was small with no patient experiencing permanent deficits.

The authors concluded that deep brain stimulation provides significant improvement in patients with treatment-resistant depression. The stimulation likely acts by modulating brain networks whose dysfunction leads to depression. They observed that the procedure was well-tolerated and benefits were sustained for at least one year.

Comments

[TTND]

Is this surgery safe? I think music or meditation will do just fine if one is willing to do it. It may take longer to heal but better than medications.

[lola]

The study does not specify what specific area or network of the brain in which this method stimulates. Moreover, since it is claimed to be reserved for treatment-resistant depression, I wonder how much it would actually cost. Although it is considered well tolerated now, most of the brain adverse effects are long-term and latent for years. Personally, I think it is a little too risky to get your brain stimulated in such way.

[AG]

Deep brain stimulation has yet to be approved by the FDA for depression treatment and is presently in its early stages of investigation. This invasive neurosurgical treatment is projected for those who suffer from chronic depression. The brain is stimulated with electrical impulses and requires brain surgery. A device is, in fact, implanted in the chest and electrodes are implanted in the brain. Under the skin wires are used to connect the electrodes to the neurostimulator, which aid in sending electrical signals to the brain, affecting the mood centers. This treatment is expected to terminate depression completely; however, it has been noted that this treatment will gradually, over several months, demonstrate improvements in depressive symptoms. Personally, I feel this invasive cure must be deeply researched pertaining to its safety and effectiveness.

[Kimberly S.]

Is it ethical for researchers to enroll depressed patients in a study that involves such an invasive procedure? The subjects in the study had depression that was resistant to medications. So, did the subjects really understand (or even care about) the potential risks before they signed up?

[Mike]

There are several places that scientists can put a deep brain stimulation implants to improve mood, such as the nucleus accumbnes. See the link in my name for more information.

[Heather]

Deep brain stimulation is most commonly used to treat symptoms of Parkinson’s disease, such as tremor, rigidity, stiffness, slowed movement, and walking problems. More than 35,000 people worldwide have DBS electrodes in their brains, and 250 facilities in the United States perform the procedure.

In addition to depression, DBS has also been studied as a possible treatment for obsessive compulsive disorder, epilepsy, chronic pain and Tourette's syndrome.

[SpecialK]

Kimberly, you bring up a good point about the ethical considerations. I would also like to know how this was addressed, if at all. Other comments about the invasiveness and safety of this procedure are also important.

However, speaking as someone who has known two people with treatment-resistant depression who ultimately took their own lives, I think this deep-brain stimulation could literally be a life-saving treatment option. Of course more studies need to be done, and the cost-benefit ratio worked out, but for people who have tried standard and non-standard drug therapies, psychotherapies, meditation, etc., without success, this may have real potential.

[Ann]

Deep brain stimulation hasn't been approved by the FDA for the treatment of depression. It seem like a very serious and risky procedure because it involves in brain surgery. Some of the side effects are infection, bleeding and headache. More information related to side effects: http://www.mayoclinic.com/health/deep-brain-stimulation/MY00184/DSECTION=risks

[Ashley]

While it has not been approved by the FDA for the treatment of depression, it has been approved to treat Parkinson’s disease, severe muscle spasms and chronic pain. Presently, this treatment option has been studied for epilepsy, cluster headaches, severe mental illness and obsessive-compulsive disorder (OCD).

In an early study looking at this treatment option in six patients with chronic, severe depression who were refractory to other treatment regimes, the study outcome resulted in four out of the six patients who underwent treatment conceivably better one year post treatment. In another study it was noted that three out of four OCD patients who received this treatment improved significantly.

[willy]

I agree with SpecialK. Although it may seem unsafe and somewhat unethical, it is the last option for those who have tried and failed conventional medicines and therapies. Depression is a critical illness in such a way that at one point, a person’s life can just be taken away in one snap of a finger. Thus, I personally feel the need to put aside many doubts and skepticisms, and for once, let this be the last and hopefully, the best hope for someone’s life.

[Phil]

Although deep brain stimulation may have side effects ,such as those mentioned by Ann in a previous comment, traditional, first-line treatment for depression, such as the use of SSRIs and other antidepressants, such as TCAs, are not problem free either. Oral antidepressant medications have been shown to potentially worsen depression, leading to an increased risk of suicide, especially in young adults. On top of that, having a patient on an oral antidepressant can potentially lead to drug interactions. There is no treatment or therapy out there that is risk free.

[wendy]

Ethically speaking, the patient’s chronic depression will inevitably factor into his/her decision whether or not to participate in studies; however, it may be the chance they have been waiting for. There are obvious risks to brain surgery, but look at the alternative they have been suffering through for the past years. I have seen the traumatic effects that chronic depression can have on a person and his/her family and friends. DBS can be a last line outlet. It’s definitely a cost-benefit ratio, but it’s a risk that may be worth taking.

[Hal]

Deep brain stimulation also goes by another name, electroconvulsive therapy (ECT). Back in the earlier days (1940s-1960s), when this procedure was performed, muscle relaxants were not used. Patients needed to be strapped down to their beds, since the electroconvulsive therapy lead to very intense seizures. The results of strapping down patients during ECT were bruises and broken bones. These days, the use of neuromuscular blockers, such as succinylcholine (a depolarizing neuromuscular blocker), helps prevent the breaking of bones due to the induced seizures.

[Jonathan]

I am anxious to see the effects of this surgery in the long-run. So far patients have sustained improvements for 12 months, but what about five or 10 years down the line? How many additional surgeries will be needed to replace the battery in the chest device? Do those extra surgeries pose additional risks? Can or will resistance develop to this therapy? Will patients use drug therapy as an adjunct to the surgery? There may be latent effects on the brain that surface years down the line. I hope for the sake of the patients that they are not dangerous.

[naomi]

Though this procedure seems very invasive and risky, it could have promising outcomes in disease therapy. I read that DBS is comparable to a cardiac pacemaker. Cardiac pacemakers help to maintain an appropriate cardiac rhythm, while DBS is presumed to help modulate dysfunctional circuits in the brain so that the brain can function more effectively.

[Karen S.]

I wonder if this procedure was or could be offered to people who have been given unsuccessful treatments of shock therapy to "cure" their depression. I am assuming that the subjects of this study were in serious need of help to risk a surgical procedure. That is why some have chosen shock therapy. Most of us have known situational depression and how it colors our feelings about life and everything in it. To be chronically depressed must be one of the toughest conditions to endure. To live without hope has to be the worst situation. I don’t know which is more risky in the long run, having a surgical procedure, which on the face of it seems the more threatening, or going through pill after pill without results and having to deal with and treat the side effects of the various medications. I think if I experienced serious and debilitating a depression, I would be grateful for some hope of relief, regardless of its form.

[tasha]

I wish there was more emphasis on investigating other types of therapy for depression, at the very least as supplements to medication and other more invasive options such as deep brain stimulation. Walking, for example, has been shown to lower symptoms of depression in women with breast cancer, depressed Alzheimer’s patients, as well as depressed and anxious adults. And what about yoga and acupuncture? It seems like there are other less invasive, life-altering paths to explore.

[Pete]

I do not doubt that deep brain stimulation will work for depression and is safe. I know it is often used for epilepsy and they consider it safe enough to use on pregnant women. (I was shocked to learn this too.) But I also wonder how long the effects will last. Depression may sometimes go away with the use of medications and ECT, but what about the times when taking a pill does not cure depression? Shouldn't the first line treatment for depression be therapy, then expensive drugs or intense procedures?

[Lauren]

I agree with Tasha S’s comments about alternative treatments for depression beyond drugs. For instance, music therapy has been shown to be effective in elderly patients with depression and also has other positive effects such as decreased heart rate, respiratory rate and blood pressure. Another alternative treatment may be yoga, although more studies are needed to determine the true effectiveness. I wonder if alternative therapies were tried in these “treatment-resistant” patients.

[Ree]

I would like to hear more about the other changes that happened to the DBS participants. There may have been good benefits for depression, but the brain is such a complex organ, I feel other things can happen too. The article suggests that the adverse events that occurred were not permanent, but they must have some impact on the overall quality of life. These initial results are otherwise promising, especially for those who find taking daily oral medication difficult.

[Jason]

I think it is good that research is being done in brain stimulation for depression. Although the procedure is invasive and may have side effects, I think it is important to explore and study all possible treatment methods. If medication and other commonly recommended treatments for depression don't work for someone with depression, then invasive procedures such as these might be their last hope. I hope further research can be done to see if this is something more people could use.

[Madison]

Stimulating areas, such as the nucleus accumbens, seems to only enhance feelings of pleasure and reward. I wonder if this is actually beneficial for treating the areas of the brain affected by depression? The link Mike included alludes to that point and says that the feelings of sadness associated with depression never went away with this type of brain stimulation. Stimulating the reward system seems like it might just be a temporary fix and not a long-term solution for treating depression from the viewpoint of the brain.

[Supporter]

Many well-known therapists believe that biological and psychological factors both play a large role. I will try to deal with the biological one:

Feelings of depression are caused by a chemical change that affects how the brain functions.

A normally functioning brain is a giant messaging system that controls everything from your heartbeat, to walking, to your emotions. The brain is made up of billions of components with called nerve cells, or neurons. These nerve cells send and receive messages from the rest of all your body, using brain chemicals called neurotransmitters.

These chemicals in the human brain are responsible for our emotional state. Depression happens when these chemical messages are not correctly sent or received between brain cells, which affect the communication.

For example, if your telephone has a weak signal, you can't hear the person on the other end. So it is disabled or unclear

It has been proposed that even the people who already suffer from depression have a way to treat it passed on the biological side - this way is the medications. The main role of the medications is to fortify weak signals by raising the levels of certain neurotransmitters, which guarantee that the brain's messages are submitted loudly and clearly.

More information and related topics at my blog:
http://no4depression.blogspot.com

[Tamara .S]

DBS is currently experimental and carries the same serious risks as other brain surgeries, including risk of hemorrhage, seizures and infections. Therefore, there is little known about long-term effects and why some people don’t respond to it. DBS can be physically uncomfortable, and insurers may not cover the treatment.

[Natalie]

Very interesting! This neurosurgical procedure seems very invasive and risky, so I can understand why it’s reserved for treatment-resistant cases. However, I have experienced severe depression at one point in my life and empathize with those people. They would take any opportunity or chance that may come their way to alleviate the dreadful symptoms. I may however recommend acupuncture first or other holistic modalities before rushing into a dangerous surgery, especially since we don’t really know the long-term outcomes of this surgery.

[Johnny]

Lots of posters on this board seem to be largely missing the point regarding DBS for depression. Severe depression is an extremely serious illness that pushes around 15% of sufferers to take their own lives, and this percentage may well be much higher for patients who suffer from treatment-resistant depression. The more treatment resistant a patient is, the less well-tested (and potentially less safe) treatments they are subjected. I am shortly to undergo DBS for treatment-resistant depression after several episodes became increasingly hard to treat with conventional drugs and psychological therapy. I am now in the terrifying position of not responding to anything and have been incapacitated and living as a shadow of my former self for nearly two years now. The choice for me (and I suspect many other sufferers) is a simple one: between a future of unremitting depression and very probable suicide or taking this valuable chance to get better.

I hope that doctors and researchers continue to work on new treatments like this, as they offer hope to desperate people and the existing treatments simply don't work for a significant proportion of people. I wish anybody in my position luck and hope that I will be one of the patients to benefit from a treatment where the benefits would seem to far outweigh any risks.