Friday, July 25, 2008

Wham: Deep Brain Stimulation a Difficult But Proven Treatment for Depression

There are some who suffer from depression, but who are considered "treatment resistant." In other words, their depression may run a bit deeper than the mild-to-moderate level which can be effectively dealt with by pharmaceuticals (or herbal support from products like Arctic Root®). For these treatment resistant people, there is some hope in a technique called "Deep Brain Stimulation." In fact, a new study of this technique shows promising results in this patient population.

This new data shows that the intervention is generally safe and provides significant improvement in patients as early as one month after treatment. The patients also experienced continued and sustained improvement over time. The study is reported on in the online issue of Biological Psychiatry by scientists from the University of Toronto and Emory University School of Medicine. The study began at the University of Toronto in 2002, led by Helen S. Mayberg, MD, and collaborators Andres Lozano, MD, PhD, neurosurgeon, and psychiatrist Sidney Kennedy, MD. Mayberg herself has over 20 years of research into brain imaging technology that characterizes functional brain abnormalities.

Deep brain stimulation uses high-frequency electrical stimulation targeted to the specific areas of the brain involved in neuropsychiatric disease. Twenty patients received this treatment for 12 months. Twelve of 20 patients experienced a significant decrease in depressive symptoms by six months, with the remaining seven patients essentially in remission. Benefits were largely maintained at 12 months with continued stimulation. No long-term side effects were reported.

Each study patient was implanted with two thin wire electrodes (one on each side of the brain). The other end of each wire was connected under the skin of the neck to a pulse generator implanted in the chest -- similar to a pacemaker -- that directs the electrical current. The researchers regulated the intensity of the current according to the response of the patient. Only patients who were unable to get better with most other types of antidepressant treatment -- including medication, psychotherapy and electroconvulsive therapy -- were included in the study.

"We postulated that if stimulation worked for the treatment of other neurological disorders where abnormal function of specific circuits was well established, such as Parkinson's disease, then stimulation of the Cg25 region within this apparent depression circuit might provide significant benefit for patients with treatment-resistant depression," said the authors. And, evidently they were right.

A new trial at Emory will soon tackle a number of unanswered issues including the testing of patients with bipolar depression and refinement of the targeting and selection of the electrodes using new imaging techniques. The Emory study will enroll 20 patients and will be conducted over a period of at least three years.

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