The 'brain's pacemaker' makes untreatable depression treatable

The ‘brain’s pacemaker’ makes untreatable depression treatable

This may be the breakthrough that psychiatry has been waiting for for years.

Unfortunately, depression is a common problem. Fortunately, a psychiatrist or psychiatrist can often help. But for a small percentage of patients, behavioral therapy or medication is insufficient; They suffer from severe and irreversible depression. So is Sarah (whose last name has been deleted at her request). “I was at the end of my pregnancy. I was so depressed (…) This was not a life worth living.” But thanks to the work of researchers at the University of California (San Francisco), her situation has changed abruptly and radically. After years of unsuccessful treatments, her depressive symptoms finally subsided. “At first the emotions and darkness were overwhelming, but now I get up and go on with my day.”

pacemaker
It’s all thanks to a small device implanted in her brain that – when needed – stimulates a specific part of her brain. Kind of a pacemaker, but for the brain.

deep brain stimulation
This isn’t the first time researchers have used so-called deep brain stimulation to try to reduce or treat symptoms of depression. But previous attempts have been only limited or have been unevenly successful. This has to do with the fact that most brain implants used for this purpose constantly emit electrical signals and can often only be used in one brain region. The latter is uncomfortable, because the areas of the brain that produce symptoms of depression can vary from person to person.

Personalization
Reason enough for American researchers to develop a different approach. The result is a brain implant that stimulates the brain only when it is really necessary and also focuses on the area of ​​the brain where the stimulation has the greatest positive effect on the mood of the patient in question (see box).

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As mentioned, symptoms of depression in a person can arise from different brain regions than others. For effective deep brain stimulation, which is aimed at treating depressive symptoms, you must identify for each patient the region of the brain that responds best to the stimulation. The researchers demonstrated this by placing ten electrodes in different areas of the brain and alternately stimulating these brain regions and seeing how the patient responds. In Sarah’s case, ventral striatum stimulation was found to improve mood the most. In doing so, the researchers found a brain region that they could stimulate. But they preferred to stimulate that brain region only when it was really necessary, that is, when her mood threatened to deteriorate. This is also possible. The researchers showed that the onset of depressive symptoms coincides with a specific pattern of brain activity that can be specifically measured in the amygdala. The researchers then developed a brain implant that continuously measures brain activity in the amygdala and, once the abnormal pattern is detected, stimulates the ventral striatum.

The results were impressive. “We were able to offer this tailored treatment to a depressed patient and relieve her symptoms,” said researcher Catherine Skangos. And while it may take weeks after standard treatments for depression symptoms to subside, Sarah noticed almost immediate results. Not only shortly after implantation, but also in the fifteen months that have passed since the implant was placed. “In the first few months, my depression abruptly eased so abruptly that I wasn’t sure it would continue like this,” Sarah said. “But it stayed that way. And I realized that the device enhances the therapy and self-care that I learned to practice.”

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future
The hope, of course, is that more people with “untreatable depression” can be treated in the future. “The idea that we can treat symptoms as they arise is an entirely new way to treat even the most difficult to treat depression,” Skangos said.

But more research is needed before this treatment can be widely published. The clinical trial is currently being expanded to include two new patients and we hope that nine more will soon follow. A follow-up study should show whether the approach also works well and for a long time for others. Scientists also hope to gain more insight into the areas of the brain implicated in depression. This may also lead to entirely new treatments in which activity in these brain regions can be modified in a less drastic manner.

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