Deep Brain Stimulation for Depression?
On April 19, 2008, during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago, researchers from the Cleveland Clinic, Brown University and Massachusetts General Hospital presented results of a study claiming that deep brain stimulation may be an effective way to treat depression and Obsessive Compulsive Disorder. The research which has been ongoing for several years evolved out of the success of DBS in treating the tremors associated with Parkinson’s, dystonia and epilepsy.
Depression is considered to be the highest cause of disability worldwide by The World Health Organization, but most people who suffer from major depression do respond to therapy and medication to some degree. There is however a group of patients that are considered to have treatment resistant depression that do not respond at all. The procedure, intended for these patients will hopefully raise their quality of life and reduce their high suicide rates.
According to Psychiatric Secrets, 2nd ed., treatment resistance is frequently defined as failure to respond to an adequate trial of at least two standard antidepressants. Treatment resistant patients may also initially respond to an antidepressant, but quickly develop a tolerance to it.
Originally it was thought that it was a chemical imbalance that caused depression, now even though the chemical imbalance is still considered part of the problem researchers are looking at electrical activity in the brain as well. “Depression is a physiological disorder, and basically we are regulating the abnormal signals to brain causing the depression,” says Dr. Ali Rezai director of the Center for Neurological Restoration at the Cleveland Clinic in Ohio.
The procedure involves implanting 2 very small electrodes into very specific parts of the brain. The electrodes will emit tiny impulses of electrical stimulation to correct the abnormal brain activity. The advantages of DBS are that it is reversible, nondestructive and that it can be adjusted after implantation.
Dr. Rezai and his colleagues enrolled fifteen chronic and severely depressed patients in their study. All the patients were considered treatment resistant. Of the 15 patients improvement was seen in 7 patients in 6 months, 11 at 12 months and eight out of the 15 at the final follow-up. Also, there were also no problems with the devices.
“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,” Dr. Rezai said in a press release. “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.”
On April 29th Dr. Rezai released similar studies on another group of patients with similar results.
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