Brain Stimulation for Treatment Resistant Depression
A new research study confirms that deep brain stimulation (DBS) is a potentially effective treatment option for people with treatment resistant major depression.
Researchers from the Cleveland Clinic, Brown University, and Massachusetts General Hospital were inspired by the success of DBS in treating the tremors associated with Parkinson’s and movement disorders like dystonia and essential tremor.
“Starting in 2001, we began treating patients with obsessive compulsive disorder (OCD) with promising outcomes. These findings resulted in the initiation of a subsequent trial for patients with severe and medication intractable major depression, starting in 2003,” stated Dr. Ali R. Rezai, MD, director of Cleveland Clinic’s Center for Neurological Restoration.
The World Health Organization rates major depression as the top cause of disability worldwide. While many patients with major depression find relief through a combination of psychotherapy and medication, some people are left severely disabled.
Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.
DBS surgery involves the placement of tiny implantable electrodes into specific parts of the brain that are functioning abnormally. These electrodes emit tiny pulses of electrical stimulation to block the abnormal activity in the brain, which causes a variety of symptoms – such as pain, tremors, movement problems; as well as obsessions, moods and anxieties associated with psychiatric disorders.
The success of DBS is dependent on the surgical team’s ability to precisely pinpoint the specific brain area for stimulation. The advantage of DBS is that it is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation.
“The preliminary results of research undertaken between 2003 and 2005 indicated that bilateral DBS of the anterior limb of the internal capsule holds promise for the treatment of intractable major depression, which led to the more extensive research results being presented today,” added Dr. Rezai.
Fifteen chronic and severely depressed patients were enrolled in this study. These patients had failed multiple medication trials, as well as psychotherapy and electroconvulsive therapy (ECT). These highly intractable and often suicidal patients underwent bilateral DBS implantation in the ventral internal capsule/ventral striatum (VC/VS) at the three institutions.
The following outcomes were noted:
- Responses were seen in seven (47 percent) of 15 patients at six months, five (45.5 percent) of 11 at 12 months, and eight (53.3 percent) of 15 at last follow-up.
- Long-term improvement in depression severity, functioning, and quality of life were all noted.
- Measures of short-term memory improved.
- There were no hemorrhages, infections or other neurological deficits.
“This research substantiates our earlier findings, which indicate that bilateral DBS of the anterior limb of the internal capsule holds promise and hope for select patients suffering from severe and treatment resistant major depression, stated Dr. Rezai.
“While about half of this patient group responded to treatment, I feel that as we learn more about this rather new technology, efficacy will continue to improve. It is important to understand that this treatment is not for everyone with major depression and only for those that have tried various medications, psychotherapy and ECT. But, nevertheless, it is very promising news for the many suffering patients and their family members that have virtually given up hope.”
Nauert PhD, R. (2008). Brain Stimulation for Treatment Resistant Depression. Psych Central. Retrieved on April 28, 2015, from http://psychcentral.com/news/2008/04/30/brain-stimulation-for-treatment-resistant-depression/2206.html