Brain stimulation may curb persistent depression

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Individuals with severe depression who do not respond to standard types of treatment may be helped with an experimental treatment called deep brain stimulation, Canadian investigators report.

Four of six severely depressed patients who underwent deep brain stimulation, which involves surgically implanting electrodes in a targeted area of the brain thought to be involved in depression, experienced a “striking and sustained” let-up in their depression, investigators report in the medical journal Neuron.

The six patients had been suffering with depression for between 1.5 to 10 years, despite treatment with antidepressant medications, psychotherapy and electroconvulsive therapy, according to the team.

When the electrodes were “turned on” patients reported effects such as sudden calmness, heightened awareness and increased interest. They also exhibited increased motor speed and higher rates of spontaneous speech.

After 2 months of continuous electrical stimulation, five of the six patients exhibited decreases in their Hamilton Depression scores of at least 50 percent. At 6 months, four continued to have an antidepressant response.

Other improvements included increased energy, interest, and psychomotor speed, decreased apathy and improved ability to initiate and complete tasks.

What was it that differentiated the two nonresponders from the four responders to deep brain stimulation? According to study investigator Dr. Helen S. Mayberg from Emory University in Atlanta, the four who improved, but not the other two, had “early onset depression with classic melancholic features.”

The responders are “well past a year” since electrode implantation, and “they continue to be well, so it is very encouraging,” she added.

“We need new treatments so that a patient does not go through 5 years of drug cocktails and every possible combination of pills and electroconvulsive therapy before coming to the conclusion that you need something else,” she said. “Why should people suffer that long, when maybe we can do something that will give true relief?”

Deep brain stimulation has been used with some success in the treatment of epilepsy and Parkinson’s disease.

SOURCE: Neuron, March 3, 2005.

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