Depression: The Pleasure Pacemaker

25. July 2017
Share article

For patients with severe treatment-resistant depression, there may soon be a new treatment option. In one four-year study, seven out of eight patients benefited from deep brain stimulation. Four of the patients were cured.

Severe depressions are treated using various existing therapeutic approaches. Among these are both medication based and/or psychotherapeutic treatments, as well as stimulation procedures like electroconvulsive therapy. However with some patients none of these therapy options hits the mark – such patients are considered to be “incurable”. Not infrequently, these people end their lives themselves because of continual hopelessness.

Deep brain stimulation for severe depression

Doctors in the Division of Interventional Biological Psychiatry at Freiburg University Hospital’s Department of Psychiatry and Psychotherapy (Germany) have now been able to show in a long-term study that these people can also be helped. The Freiburg therapy method is based on deep brain stimulation. This form of stimulation has been able to alleviate the symptoms of patients with previously untreatable, quite severe forms of depression over several years, or even cure them. The procedure has already become established in use on Parkinson patients, where brain stimulation has been used successfully for years as a standard procedure against movement disorders.

Implantation in an eight-hour, complicated operation

Eight patients participated in the small long-term study. All suffered from a severe depression which had not yet responded to treatment, and which had persisted for a period from three to eleven years. The Freiburg doctors, in an eight-hour complicated operation, through a hole in the skullcap implanted thin electrodes in the brain of these patients; through these electrodes the superolateral branch of the medial forebrain bundle, which is responsible for the perception of pleasure, is able to be stimulated. This brain region is also important with regard to general motivation and therefore for the life quality of the patient.

The stimulator is similar to a pacemaker. It continuously transmits weak electrical pulses of 3 to 5 volts to the respective region of the brain. Following implantation, brain stimulation is adjusted precisely to the patient in an approximately eight week long procedure.

Long lasting effectiveness from the first month

The success of brain stimulation was assessed by doctors every four weeks by using the already established Montgomery-Asberg Rating Scale (MARDS), a questionnaire for assessing the severity of depression. The scale ranges from zero to 60 points; 10 points and over means that a depression is considered to be present.

Already after four weeks, the MARDS score fell from an average of 30 points to 12 points. By the end of the study four years later the point level had even declined slightly further. Four patients fell below the depression threshold of ten points. Overall, seven of the eight treated patients had sustained improvements in their symptoms right until an observation time point following 4 years of continuous stimulation. The therapy remained equally effective over the entire period.

170725_Depression_Freiburger

The Freiburg doctors through the use of electrodes stimulated a region in the brain which is involved in the perception of pleasure. This alleviated the depression in seven of the eight treated patients. © University Hospital Freiburg

“Other forms of therapy often lose their effectiveness over time. Therefore deep brain stimulation is a promising approach for people with depression who have not yet been successfully treated”, Thomas Schläpfer, head of the Division of Interventional Biological Psychiatry at the Department of Psychiatry and Psychotherapy of the Freiburg University Hospital, says.

Adverse effects can be avoided by adjusting the stimulation

In some patients, brain stimulation caused short-term blurred vision or double images. These blurred vision were however able to be remedied by the doctors by adjusting the stimulus strength. The antidepressant effect of the stimulation was not affected through this. None of the patients suffered personality changes, mental disorders, or other side effects.

Study director and psychiatrist Thomas Schläfer says: “It is quite unbelievable that in these severely ill patients a relatively simple stimulation, which has hardly any side effects, has shown this effect over four years. That I believe is really a breakthrough”.

Possibility of European registration

Volker Coenen, a neurosurgeon at the University Hospital of Freiburg, assumes that deep brain stimulation could for severely depressed people become the standard procedure, without involving other treatment options. In this context, the promising results of the first long-term study which came to an end in early 2017 needs to be repeated with 50 subjects, he says. Prof. Coenen then sees the possibility of a European registration of the therapeutic procedure, in accordance with which the therapy might also be used on patients beyond clinical trials.

 

Source:

Bevernick, B.H. et al. Deep brain stimulation to the medial forebrain bundle for depression- long-term outcomes and a novel data analysis strategy. Brain Stimul. 2017 May – Jun;10(3):664-671.

5 rating(s) (4.6 ø)
Image copyright: Martin Fisch, flickr / Licence: CC BY-SA

Comments are exhausted yet.

1 comment:

Angelica Ursula Landau
Angelica Ursula Landau

EVEN NOT BEING OF MY AREA (ANIMALS), IT IS VERY IMPORTANT TO KNOW THAT DEPRESSED PEOPLE (SOMETIMES EVEN VETERINARIANS), HAVE A WAY OUT OF PSYCOTROPIC DRUGS, AS A THERAPY.

#1 |
  0
Copyright © 2017 DocCheck Medical Services GmbH
Language:
Follow DocCheck: