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Deep Brain Stimulation (DBS) for Depression: Long-Term Followup

Is deep brain stimulation (DBS) an effective treatment for chronic, treatment-resistant depression?

According to a new study, it is. But sadly, without a control group, the researchers can’t really say whether it was their treatment — DBS — that helped people with their depression, or whether it was simply the passage of time. Furthermore, the study did not show that actual DBS treatment is more effective than placebo treatment — so-called “sham” treatment (where a patient undergoes the procedure, but nothing is activated afterward).

This last point is important, because other studies conducted on other alternative depression brain treatments have shown mixed results when it comes to comparing them to placebos. In multiple studies, researchers have found no significant differences between the real treatment and the placebo or sham treatment.

12 Comments to
Deep Brain Stimulation (DBS) for Depression: Long-Term Followup

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  1. Thank you for writing this… I have been watching for alternative treatments to come around. I have Bipolar II and ECT helps immensely, but I wish I didn’t have to go so often… but I haven’t heard much about DBS (or TMS) in long-term studies.

    I agree that ECT feels archaic, but I have to say that at the same time it saved my life quite literally. Or… of course… the thought of ECT working saved my life. Never underestimate the power of placebo.

  2. With regards to my ECT treatment I should clarify that I was being a bit tongue-in-cheek in that the treatment does work for me in my opinion… and I certainly notice a decline in it’s effect as time goes on between treatments.

    Reading between the lines [from this and other articles] I get the impression that you don’t care for ECT… and while I can understand the concept of putting electricity to the brain, DBS puts the electricity directly into the brain but in a different manner. Given the option, today, of ECT or DBS I would likely stick with ECT as it works and DBS seems more invasive with brain surgery required and the lack of detailed studies. ECT is lacking studies in some ways but it does have a record of working for treatment-resistant cases such as mine.

    Just sharing a pt-perspective.

  3. I asked my psychiatrist’s opinion of DBS for major depression, and he didn’t have a very favorable opinion of it. I got the impression he thought it was pretty worthless.

  4. this is good. i am like you and basically crave a new way out of this state.

  5. Thank you for sharing your insight. I have BipolarII and the depression is very debilitating. Meds have helped but I hope for so much more. I am very reluctant to try anything likeECT..fearful of memory loss (an issue I am dealing with already).

  6. I was in the FDA studies for Cyberonics’ Vegal Nerve Stimulator trials. They had a “sham” group – of the 250 US participants, all had the implant surgically installed (the leads were attached to the vegal nerve in the neck instead of DBS) and then 2 weeks later met with the “programmer” who at random either turned the implant on of left it off. The participants were told they would all see their programmer but that they (the study participants) would not know if the programmer turned their implant on or left it off. Then, if I can remember, the participants were told that after two months everyone’s implant would be activated (basically meaning if you were one who had their’s left off it would be turned on and you would know it). Unfortunately, the treatment didn’t work for me after having it in for 2 years. It didn’t pass through the FDA the first time, but only after a second attempt with more data did the procedure pass FDA’s approval. However, the data was not promising and many groups petitioned the FDA to have it removed from the market.

    That was back in 2001 I believe. I have no idea if this treatment is still available. If interested, I’d google “cyberonics” and “vegal nerve stimulator” for more information.

  7. Deep Brain Stimulation Surgery CAN be used with sham treatment. It has been done before in various movement disorders.

    This is not to say the individuals who are assigned sham treatment will not be offered the real treatment after the sham portion of the study is done; it simply means they are not given active treatment during the sham portion of the study.

    This has been done in various Deep Brain Stimulation studies including one for Tourette Sydrome.

    However, there’s another problem with the idea of stimulation and determining if it’s really the stimulation causing the effect–in some cases, the electrode creates what is called a microlesion, which means it basically destroys a miniscule region of brain tissue, the effect of which is almost always temporary; but whether or not the lesion forms is an important thing–is it simply having the surgery that improve ssymptoms, or actually the stimulation itself? Research currently shows in other disorders, stimulation is the main cause of symptom relief.

    Another problem with your ascertation–DBS has potentially fatal complications, compared to ECT which is almost always physically safe, even if it causes cognitive dysfunction. DBS surgery in itself raises the risk of brain infection, aneurysm, stroke, and bleeding within the brain, as well as: seizure disorder, worsening or onset of depression and/or suicidal behavior, migration of electrodes causing stimulation of a different part of the brain than inteded, which can result in a wide range of neurologic effects, numbness and tingling near the stimulator site, infection of the hardware, and frequent programming sessions until the proper setting is found.

    Then every three to five years, depending on the stimulator settings, one must have the batteries changed through surgery, which requires general anesthesia, which has its own complications.

    Aside from that, DBS costs anywhere between 45,000 and 200,000 US dollars, sometimes significantly more than that depending on complications and care required for side effects and the cost of repeated surgeries to change batteries, readjust electrode placement, etc etc.

    So while DBS can help avoid some side effects of medication for various disorders, it is not a “simple fix” in and of itself; far from it. In very rare cases, individuals DO DIE due to complications of DBS notoriously, stroke and brain bleeding. In some cases, it simply does not work, even for Parkinson’s Disease for which its use is well-established.

  8. TMS is now established as an effective treatment for treatment resistant depression. I have found TMS to be provide remarkable results for patients who have not responded to medications and/or psychotherapy.

    Unfortunately, Major Depression tends to be chronic and so there is always a chance of relapse, but the therapeutic benefit of TMS is usually long lasting and can be maintained with the help of the development of healthy habits, continuation of psychotherapy, and/or sometimes low dose antidepressant monotherapy. Our practice is currently a part of a long term outcome study, which should help contribute to the growing body of evidence which demonstrates the long term benefits of TMS.

  9. My aunt had dbs
    5 year later the dr. Goes in to change batteries
    Now aunt in hospital Worse than before she had first surgery.

  10. I’ve been waiting since I was 16y/o for something different like the DBS for refractory depression as I’m now 44y/o and have tried over 100 medications along and in combination along with 70 ECT right after high school with any effect at all so TMS wouldn’t be any better. I might try the Ketamine IV study next as it promotes synapogenesis and if that doesn’t work try the DBS as treatment resistant depression has run my life and only the MAOI in super high doses particularly the Parnate along with buprenophrine, and extreme physical exercise and other alternative treatments I researched by the NIMH such as cold shower therapy and sleep deprivation, but after over half of my life depriving myself of sleep by forcing myself to stay awake one or two nights in a role to get the antidepressant effect, I had to stop, but it got me through my colleges, medical education and I worked for twenty some odd years but know I have osteoarthritis from working out to hard. We need to develop more Kappa receptor antagonists like buprenorphine affecting the opioid system as everything with depression has an overactive metabolism or use to much glucose as shown on PET scans and only when depression goes into remission as shown on a PET scan does the glucose metabolism stop being overactive). Either DBS or more Kappa Receptor Antangonists affecting the endorphins, enkephalins.

  11. “too” much glucose.

  12. “now” I have

  13. I’ve tried nearly everything for treatment resistant depression. For twenty years it started as postnatal depression. Every medication, different combination, numerous times in hospital. I’ve had a vns implanted which has helped some I’ve been having ect for the last 20 years & it doesn’t work any more. I want to try DBS as I don’t want to keep living like this @ don’t want to put my family through this any more. I will keep trying for me & my family. I feel DBS is a last resort for me but what i’ve read about it I am not scared but realize it has been around for not very long & there is a lot they still don’t know about it. But anything is worth it after what I have been through its been hard & wouldn’t wish it on anyone. I would like all the health boards to talk to people to these people that are suffering so much & not make excuses about what happened with psychosurgery years ago & move on with the times & all the research that has been done.



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