Recently a patient who has struggled with depression foryears, and who doesn't like taking an antidepressant every day, asked whether anew technique, called deep brain stimulation, might be something to consider.
The short answer is maybe, butat some point in the future.
The FDA has so far approved deep brain stimulation only forthe treatment of Parkinson's disease, dystonias (severe muscle spasms), andcertain kinds of chronic pain. It is under investigation for patients with depression,and research on its use in depression has really just begun.
Even so, the technique bears watching, because one early butwell designed study found it was promising for people with recurrentdepression. A larger study is now underway.
So just how does deep brain stimulation work?
A surgeon implants electrodes at precise locations in thebrain and connects them with a thin wire to an electrical generator in thechest, sometimes called a brain pacemaker. The generator can interrupt activityor excite inhibitory neurons in the circuits where the electrodes are placed.The apparatus is programmed with a magnetic device passed over the skin thatadjusts the current, duration, and frequency of the electrical pulses. Eachelectrode has several contacts that can be manipulated separately. Stimulationcan be continuous or intermittent, and the patient can turn the machine on andoff.
In a pilot study, the treatment was given to six patientswith severe chronic depression who had not been helped by psychotherapy,electroconvulsive therapy, or drugs. Four of the six responded well and werestill doing well after a year. A larger study is now recruiting patients.
Interest in deep brain stimulation and other electromagnetictechniques has grown in recent years because of advances in brain imaging,computer control, and microelectronics. Other new electromagnetic techniquesinclude transcranial magnetic stimulation, vagus nerve stimulation, andmagnetic seizure therapy.
One advantage of deep brain stimulation is that it isreversible and adjustable. But the technique also has drawbacks. It involvesthe risks and high cost of brain surgery, and adjusting the apparatus oftenrequires many visits to a doctor. The battery that fires the pacemaker has tobe replaced every two to three years, which means more surgery.
But while this new technique shows potential and may wellwork for some people with recurrent or treatment-resistant depression, it isn'tsomething most people with depression will need. Deep brain stimulation islikely to remain a last resort, used only when other possibilities areexhausted.
Do you, or someone you know, resist taking medications for your depression? What are your concerns? Have you continued to take medication anyway or have you looked into alternatives?
Mental Health Letter
The field of mental health is rapidlyevolving, and whether your interest is professional or personal, stayinginformed about these mental health issues is no easy job. The Harvard Mental Health Letter is asource of mental health news you can trust?and it comes directly from the morethan 8,000 doctors and researchers at Harvard MedicalSchool.
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Comments: 19
But most importantly, HOW does it work? What does the stimulation do to make the person feel better? I assume it's put in a different location when they're treating depression than for something like Parkinsons', right?
I knew a veterinarian with severe Fibromyalgia. They implanted something in his brain to stop the pain, but it malfunctioned. By the time they realized it was malfunctioning, he died. I don't really understand what happened to him; that's all the info I was able to get.
I'd want to know would cell phones and microwaves interfere with it? (And why the heck DO cell phones and microwaves interefere with pacemakers, anyway??)
This sounds like it would be a better therapy than EST as it can be adjusted. The big decision is do the risks of surgery outweigh the possible benefit of the surgery.
medication religiously as prescribed and I know that it helps but I can still have days
when I don't feel useful and don't feel as if I am a contributor to our household.
I refuse electrotherapy because my mother died from shock treatment while being treated for post partum depression. I have had extensive outpatient treatment and
a long period of psychotherapy.
I take 90 mg of cymbalta and 30 mg of prozac daily. That works for me pretty well and my spouse also is not adverse to telling me when he thinks my thought process is not productive but destructive.
I really don't think most sufferers of anxietal/depressive disorders would really benefit from the type of surgery you describe. I for one, would not like to try it.
I am thankful to have Bipolar (its a living hell literally at times), but it makes me stronger in the process. It also makes me keep trying and working toward things. If I was normal, I think I would have gave up, but it motivates me more to keep trying on my goals. I know I can help others in their struggles, if I do not give up with mine.