A small study has found that inserting two tiny “pacemakers” into the base of a depressed person’s brain improved symptoms of their major depression.
The treatment is called deep brain stimulation and utilizes tiny pulses of electricity to block abnormal brain activity, according to researchers.
The researchers from the Cleveland Clinic and Brown University’s Butler Hospital took six patients who had not benefited from various other treatment options, including medication, psychotherapy, and electroconvulsive therapy, and inserted pairs of the tiny electrodes into each of them. Over the course of a year, two-thirds of the individuals had noticeable improvement, the researchers said.
“It was interesting and impressive to see how their lives changed over time,” said Dr. Ali R. Rezai, study author and head of Stereotactic and Functional Neurosurgery at the Cleveland Clinic Foundation. He continued, “they went from being withdrawn and not interacting to going back to work, and showed marked improvement in self-care and social function. They are living their lives much more fully than they were when they were stuck in the grip of depression.”
Another successful study was reported last year in the journal Neuron.
Rezai presented the findings at the American Association of Neurological Surgeons annual meeting in San Francisco this week.
The six patients – four women and two men – averaged 48 years old and had bilateral deep-brain stimulation leads implanted in a portion of the brain called the ventral anterior internal capsule. They underwent standardized and detail psychiatric, neuropsychological, and quality-of-life assessments on a regular basis, the researchers said.
After six months, 4 of the 6 showed a 50% or greater improvement, as well as improvements in quality-of-life measurements. Deep brain stimulation surgery has proven effective in the past for people suffering from obsessive-compulsive disorder (OCD), epilepsy and Parkinson’s disease, Dr. Rezai added.It’s not currently understood exactly why the treatment works, but it seems to help the brain resume normal chemical and electrical function. Rezai explained the surgery is reversible and the electrodes can be adjusted without further invading the brain. It is performed under a local anesthetic, and according to Dr. Rezai the changes in patients could sometimes be seen “almost instantly.”
“As we were testing the pacemakers, we could see immediate change in their moods,” he explained, adding that people who had not smiled in years, smiled. “But,” he went on, “this is for people with no other hope. These poor patients had failed everything. I am encouraged by the results, but we need to do more long-term and larger studies.”
Dr. Michael Blumenfield, Sidney E. Frank distinguished professor of psychiatry and behavioral sciences at New York Medical College said he is skeptical of invasive treatments with the potential to do more harm than good, especially when there are other readily available effective treatments, but added that he had not seen the study.
He went on to say that while it’s good to look for more and better ways to treat major depression, it’s too often diagnosed improperly.
“Sometimes one thinks one has a simple depression when it is a bipolar depression that needs a mood stabilizer,” he said. “Sometimes the underlying problem is substance abuse, and sometimes when one has resistant depression, the issue has psychological roots, and there is a need for psychotherapy.”
The World Health Organization (WHO) rates major depression as the major cause of worldwide disability, report the researchers. In this country alone, an estimated 9.5% of the adult population – around 18.8 million people – suffers from a depressive disorder each year. The cost to the American workplace alone is around $40 billion a year.