When Other Options Fail, Brain Stimulation May Help
Treatment may hold promise for hard-to-treat depression
(HealthDay News) -- Brain stimulation may help with depression that's resistant to treatment.
Psychotherapy, medication or a combination don't work effectively in about one-fifth of those who have depression. Studies have found that about 70 percent of them achieve some benefit from electroconvulsive therapy (ECT), but many later relapse. In ECT, an electrical shock is used to cause a seizure in the brain in order to release neurotransmitters that enhance brain function and improve mood, according to the American Academy of Family Physicians.
But now, some researchers suggest that people who've had long-term depression and have failed to respond to treatments, including ECT, could benefit from cortical brain stimulation.
The treatment involves minimally invasive surgery to place electrodes near the surface of the brain -- outside the lining of the brain, but not actually in the brain. The electrodes emit tiny, adjustable electrical pulses that block dysfunctional activity in the brain.
In one clinical trial, people with major depression who underwent eight weeks of cortical brain stimulation experienced an improvement of about 25 percent to 30 percent on a number of measures of depression and quality of life. Some participants even went into remission.
The stimulation was targeted at the left dorsolateral prefrontal cortex, an area of the brain that appears to play a role in depression.
"On average, these individuals had had depression for 27 years and had failed about 10 medication trials," the study's lead author, Dr. Emad Eskandar, an attending neurosurgeon at Massachusetts General Hospital and an associate professor of neurosurgery at Harvard Medical School, told HealthDay. "Their current depressive episode had lasted an average of six years or longer. These were very, very sick people who were out of options."
Achieving any response at all in this group of patients, he said, "is extremely promising."
In the study, Eskandar and his colleagues "also learned that improving the electrode position and giving more current got better effects, so, in the future, we have a pretty good idea of how to improve on" the treatment results achieved in the study, he said.
The findings from the research, funded by Northern Neurosciences, the company that developed the stimulation system used in the study, was presented at a meeting of the American Association of Neurological Surgeons.
Depression affects more than 20 million adults in the United States each year, according to Mental Health America. Signs and symptoms of depression include:
Feeling "empty" or hopeless
Feelings of pessimism, guilt, worthlessness, or helplessness
Loss of pleasure in sex
Lack of interest in activities once enjoyed
Overeating and weight gain, or loss of appetite and weight loss
Feeling unusually restless or irritable
Sleep issues, which could be insomnia, oversleeping or waking early in the morning
Though depression can be treated in a variety of ways, it's not always easily treated, Mental Health America says. Even if treatment doesn't seem to be effective, people shouldn't give up, the organization says, but rather should keep working with their doctor and therapist to find what works for them.
On the Web
To learn more about depression, visit the U.S. National Institute of Mental Health.
SOURCES: HealthDay News; Emad N. Eskandar, M.D., attending neurosurgeon, Massachusetts General Hospital, and associate professor of neurosurgery, Harvard Medical School, Boston; May 5, 2009, presentations, American Association of Neurological Surgeons annual meeting, San Diego; American Academy of Family Physicians (www.familydoctor.org); Mental Health America (www.mentalhealthamerica.net)
Author: Robert Preidt
Publication Date: May 31, 2010
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