Deep Brain Stimulation Shows Promise in Treatment of Major Depression and OCD

Researchers from the Cleveland Clinic and Brown University's Butler Hospital will present results of a study that shows deep brain stimulation (DBS) to be a potentially effective treatment option for people with major depression.

An estimated 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive disorder each year. The financial impact of these disorders is very high, costing as much as $40 billion annually in the American workplace. The United States is not alone in experiencing this major public health crisis. The World Health Organization rates major depression as the top cause of disability worldwide. While many patients with major depression find relief through a combination of psychotherapy and medication, some people are left severely disabled.

The results of this study, Deep Brain Stimulation for the Treatment of Intractable Major Depression: Preliminary Results from a Multi-Center Prospective Trial, will be presented by Ali R. Rezai, MD, 11:30 to 11:45 a.m. on Tuesday, April 25, 2006, during the 74th Annual Meeting of the American Association of Neurological Surgeons in San Francisco. Co-authors are Gerhard Friehs, MD, Donald A. Malone, MD, Linda L. Carpenter, MD, Andre G. Machado, MD, PhD, Audrey R. Tyrka, MD, PhD, Lawrence H. Price, MD, Steven Rasmussen, MD, Cynthia S. Kubu, PhD, and Benjamin D. Greenberg, MD, PhD. "Since 2001, this team of investigators has been using DBS for treatment of obsessive compulsive disorder (OCD). Because DBS for OCD showed significant benefits in improving patient's anxiety and obsessions, as well as improvements in co-morbid depression, the research team initiated a new study analyzing the effects of DBS on patients with major depression," stated Dr. Rezai.

DBS has been used to treat intractable pain for several decades, and more recently, use of this technology has expanded to the FDA-approved indications for Parkinson's disease and other movement disorders. DBS is also under investigation in the treatment of epilepsy and other debilitating neurological conditions. DBS surgery involves the placement of tiny implantable electrodes into specific parts of the brain that are functioning abnormally. These electrodes emit tiny pulses of electrical stimulation to block the abnormal activity in the brain, which causes a variety of symptoms - such as pain, tremors, movement problems; as well as obsessions, moods and anxieties associated with psychiatric disorders. The success of DBS is dependent on the surgical team's ability to precisely pinpoint the specific brain area for stimulation. The advantage of DBS is that it is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation.

This study was conducted with Institutional Review Board (IRB) and Food and Drug Administration (FDA) Investigational Device Exemptions (IDE) approval. Six patients, four females and two males, with an average age of 48, were enrolled in the study from 2003 to 2005. All six patients had a history of being highly resistant to other treatments, including medication, psychotherapy, and electroconvulsive therapy (ECT). Bilateral DBS leads were implanted stereotactically in a region of the brain known as the ventral anterior internal capsule. Participants underwent standardized and detailed psychiatric, quality-of-life, and neuropsychological assessments on a regularly scheduled basis, both pre- and postsurgically.