Deep brain stimulation (“DBS”) was originally used to help people suffering from Parkinson’s disease with symptoms such as tremors and dyskinesias (involuntary movement of head, arms, and legs). However, it may also help people suffering from depression, especially when they have not responded to other treatments. Is DBS safe as a treatment for depression?
How DBS works
In deep brain stimulation, doctors surgically implant tiny paired electrodes (one in each hemisphere of the brain) to a specific area of the brain (known as Area 25). The electrodes deliver a small amount of current to Area 25. During and after surgery, doctors can fine-tune the amount and frequency of the pulses. The device can remain in a patient indefinitely, although it does need its battery replaced every few years. There are many success stories of people who underwent DBS years ago and still live with the implants, free of crippling depression.
Studies show some people who had very little hope of a normal life before DBS. These people didn’t respond to multiple treatments for depression including talk therapy, antidepressants, and even electroconvulsive therapy (ECT or “shock therapy”). However, after undergoing DBS treatment, their major symptoms of depressed mood, irritability, irregular sleep, loss of motivation, and the inability to experience pleasure were relieved.
DBS doesn’t always work. Even the doctors who study and implement it don’t understand why it works when it does. Dr. Helen S. Mayberg, who has conducted pioneering DBS research admits that “we still don’t know how DBS works.” This isn’t exactly comforting for most people.
DBS carries a small risk of infection, stroke, bleeding, or seizures. Other potential side effects are reduced clarity of speech and cognitive decline after DBS surgery.
A further cause to be cautious about DBS is that although the FDA has approved DBS for essential tremor, Parkinson’s disease, dystonia, and chronic and severe obsessive-compulsive disorder, it has not been approved for depression and bipolar disorder.
In fact, in 2017, progress with DBS as a treatment for depression came to a halt. BROADEN was the largest clinical trial to test DBS, and for complex reasons, it was halted early by St Jude’s, a medical device maker that financed the trial. When the trial was judged based on results obtained after six months, Dr. Mayberg herself confirms that “the trial clearly failed.”
For example, Steve Ogburn experienced serious complications after his implantation. He suffered from “severe cognitive decline,” continued depression, and severe pain in his head and around the electrical leads running between chest and head, which didn’t go away even after the implants were removed.
However, promising results kept coming in from patients who had been implanted while the trial was still active. The Lancet: Psychiatry published the following results: 24 months after activation, 50% of those in the original active group reported depression scores dropping by at least 40 per cent. The remission rate also rose to 31%. Conflicting results make further study an important issue.
An earlier study conducted in 2014 concluded that DBS might become an important treatment option for some patients who are severely affected by neuropsychiatric diseases, but only after further considerable study.
It’s still early days for DBS as a treatment for major depression. It should only be considered after other treatment efforts have been exhausted, and after the patient has been informed about the various risks it poses and the conflicting results from studies. However, it may still be a source of hope for patients who suffer from debilitating depression and who are resistant to all other treatments.
Written by Gila Isaacson
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