In a given year, approximately 18 million American adults suffer from major depression. By the year 2020, it is estimated that depression will be the 2nd most common health problem in the world. An acquaintance of mine described how depression caused her to sleep excessively because, “dreaming was better than living.” Medication and therapy are popular treatments for many of the people who have been affected by depression. Current statistics show that about 80-90% of individuals who suffer with depression are able to find relief from their symptoms, but for the remaining 10-20%, referred to as “treatment-resistant,” there may be hope. Deep brain stimulation (DBS) is an experimental procedure that is gaining recognition as a safe and effective treatment for depression.
DBS is believed to have been developed in France in 1987, and was first used to treat movement disorders, such as Parkinson’s disease. Neurologist, Dr. Helen Mayberg, has spent the last 20 years researching the “neurology of depression” using functional imaging. She, along with neurosurgeon Dr. Andres Lozano, co-conducted a pioneering DBS study that involved placing an electrode on each side of the brain near a region known as Area 25. During the procedure, doctors are able to monitor the sound of neurons firing; the gray matter makes a raspy sound and the white matter is silent. The target spot is the white matter slightly below Area 25. This sector of the cerebral cortex is believed to be overactive in depressed patients, allowing negative emotions to overwhelm their thoughts and mood.
Antidepressants affect the billions of neurons in the brain, whereas DBS only stimulates an area about the size of a pea. According to Dr. Gross, who was one of the neurosurgeons involved in the first DBS experiment, “the electrodes are about the thickness of angel hair pasta and use about 1,000th the power of a flashlight bulb.” The electrodes use a customized continuous stimulation produced by a pulse generator, like a pacemaker, that is implanted in the patient’s chest.
Although DBS is not yet approved by the Food and Drug Administration (FDA), it is gaining popularity. DBS has about a 67% success rate and is a generally safe operation, but as with all surgeries, there are possible risks involved. Some complications may include: stroke, brain damage, speech problems, breathing problems, infection, and seizures. Patients who opt to undergo this procedure have decided that the possible negative side effects are not as important as the chance of living happier lives.
More research is needed before the FDA will approve the commercial use of DBS for treatment-resistant depression. Mayberg still has unanswered questions about how DBS actually works. Does DBS activate or inhibit neurons near Area25? Why does DBS help some patients and not others? Can DBS be used to treat other disorders, such as Bipolar Disorder? For the millions of people who are unsuccessful in alleviating their depression symptoms, DBS can be a life saver. Neuroscience has come a long way in the past couple decades, and I am looking forward to seeing what future research will reveal.
- Deep brain stimulation may hold promise for mild Alzheimer’s disease (medicalxpress.com)
- Battling depression with “battery-powered brains” – CNN report on deep brain stimulation (DBS) (casesblog.blogspot.com)
- Randomized Clinical Study Taps Deep Brain Stimulation to Treat Depression (medgadget.com)
- The Pros and Cons of Two Controversial Depression Treatments (everydayhealth.com)
- Results Reported for Phase Ib Open-Label Clinical Trial for the Treatment of Depression Using External Trigeminal Nerve Stimulation (eTNS™) – The USB Port to the Brain™ (sacbee.com)
- Is Deep Brain Stimulation Useful In Treating Depression? (drvitelli.typepad.com)
- Treating depression with electrodes inside the brain (cnn.com)