A new technique by German neurosurgeons and psychiatrists has relieved a case of severe, chronic depression that was unresponsive to conventional treatment.

The intervention involved stimulating a tiny nerve structure in the brain called the habenula. The habenula is located in the middle of the brain and is hypothesized to be hyperactive in severe depression. Physicians believe deep brain stimulation of this area normalizes activity.

The concept of habenula stimulation and the case study were published in the journal Biological Psychiatry.

According to backgound information in the article, some one third of patients do not respond to medication or psychotherapy for severe depression. Electroconvulsive therapy, used for such severe or treatment-resistant cases, is also not always effective.

Depressive patients have already been treated with electrostimulation with some success. However, two other areas of the brain were stimulated, located in the forebrain or midbrain regions. The habenula (Latin for the diminutive of reins) is located further downstream next to the brain stem.

“We decided to stimulate the habenula because it is involved is the control of three major neurotransmitter systems, which are known to be disturbed in depression,’” explained psychiatrist Dr. Alexander Sartorius from the Central Institute of Mental Health.

The success of the procedure was confirmed when the electrode was accidentally switched off: the patient had a bicycle accident which required surgery for which an ECG had to be made as preparation. The brain pacemaker was switched off and was not reactivated for a few days, and the depression promptly returned. A few weeks after reactivation, the patient completely recovered again.

The next step is to plan a clinical study in which habenula stimulation is to be implemented for severely depressive patients at five psychiatric-neurosurgery centers in Germany.

“We aim to show that habenula stimulation has a better success rate than other target areas attempted for depression and that it is also safe to use,” says Dr. Sartorius.

Source: University Hospital Heidelberg