Drastic Procedure Holds Promise
Deep-brain stimulation may relieve severe depression
(HealthDay News) -- A drastic-sounding procedure may be a godsend for severely depressed people who do not respond to other treatments.
For the treatment, holes are drilled into the person's skull and electrodes are implanted in the brain.
Four of six patients who received this deep-brain stimulation procedure were better six months after the procedure, and a year later they were still in remission, said co-lead investigator Dr. Andres Lozano, a professor of neurosurgery at the University of Toronto.
Deep-brain stimulation has been used successfully to treat epilepsy and Parkinson disease, but it had not previously been used to treat depression, Lozano said.
One in five people with depression do not get relief with standard treatments, including medications and psychotherapy. Some of them will respond to a mix of medications and electroconvulsive therapy, which is known as shock therapy. But some people still don't improve.
The new therapy is much more precise than shock therapy, Lozano said.
"Electroconvulsive therapy is analogous to rebooting your computer," he told HealthDay. He described it as a "very pinpointed, precise therapy, involving a very precise area of brain that plays a key role in depression."
Lozano explained, "When people are acutely sad, this area of the brain becomes active. If you take antidepressants, the activity in this area goes down."
With depression, it's "as if the thermostat was set for 120 degrees and you want it to be 70 degrees," he said. "This area of the brain is running in overdrive, and it is causing depression and also interfering with the function of areas of the brain that are involved in cognitive function."
The study involved six severely depressed people who did not improve after at least four treatments for depression. Lozano drilled two small holes into each side of the skull in a two-hour procedure that took place under local anesthesia. He inserted two wires with electrode contacts, and then tunneled the wires underneath the skin, behind the ear and down to the chest. An incision was made under the collarbone so a battery could be placed there. The electrodes were hooked up to the batteries, which can be programmed remotely through the skin.
Despite the setup, the patients had no restrictions on their activities, Lozano said.
The constant stimulation is customized for each person. When the stimulation was turned off in one participant, the depression returned within two weeks.
Lozano and his co-authors saw a "striking benefit" in four of their six patients; two did not improve. Experts don't know why the procedure helped some and not others.
Although Lozano emphasized that further study is needed, he described the early results as promising.
"It's only six people, so it's nothing to be too excited about, yet these patients really are the most refractory, and many of them had not been out of the house for several years," Lozano said. "Now they're talking about going to work, going to the gym, starting a business. It's really been a transformative experience for some of them."
On the Web
To learn more about major depression, visit the National Alliance on Mental Illness online.
SOURCES: HealthDay News; Andres M. Lozano, M.D, Ph.D., professor of neurosurgery, University of Toronto, Ontario, Canada; March 3, 2005, Neuron
Author: Anne Thompson
Publication Date: March 31, 2006
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