January 9, 2012 by Robert Wascher
Filed under Antidepressants, Bipolar Disorder, Deep Brain Stimulation, Depression, ECT, Electroconvulsive Therapy, Mental Health, Mental Illness, Psychotherapy, Suicide, Transcranial Magnetic Stimulation, Vagal Nerve Stimulation, Weekly Health Update
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DEEP BRAIN STIMULATION MAY HELP SEVERE, REFRACTORY DEPRESSION
Depression is both a common and a potentially very serious mental health disorder. According to the Centers for Disease Control (CDC), nearly 10 percent of the adult population in the United States can currently be classified as having active depression, and approximately 4 percent of the population currently meets criteria for severe, major depression.
The incidence of depression varies considerably between different groups of people. For example, women are 70 percent more likely than men to experience depression. Although depressed women are more likely than men to attempt suicide, men are far more likely to be successful in their suicide attempts. Other high risk groups include people between the ages of 45 and 64 years, people from ethnic minority groups, people with less than a high school education, people who are divorced and who have not remarried, the unemployed, and those without health insurance. (Clearly, in view of the still ongoing recession in the United States, the number of people in several of these high-risk categories has increased significantly over the past four years.)
There are multiple effective therapies available or depression, including antidepressant medications, psychotherapy, and electroconvulsive therapy (ECT). More recently, transcranial magnetic stimulation, vagus nerve stimulation, and other experimental treatments have been evaluated in patients with depression that fails to respond to conventional therapies. Another recently developed experimental therapy for severe, refractory depression is deep brain stimulation (DBS). In small pilot studies, small numbers of patients with severe depression, and who have failed every other form of depression treatment (including ECT), have had surgically implanted electrodes placed into their brains, followed by electrical stimulation of their brains through these deep brain electrodes. While it is too soon to conclude that DBS is both safe and effective in the management of severe, refractory depression, a new prospective clinical research study suggests that DBS may, indeed, produce significant remissions in refractory major depression. This newly published study appears in the current issue of theArchives of General Psychiatry.
In this small but innovative clinical trial, 10 patients with major depression and 7 patients with bipolar disorder underwent surgical implantation of deep brain stimulation electrodes into both hemispheres of the brain. Initially, all patients underwent simulated (“sham”) DBS, without the patients’ knowledge. (This sham stimulation was done to test whether or not the patients’ expectation of benefit, or a true potential benefit simply from having the electrodes surgically placed, might have influenced their depression independent of actually stimulating their brains.) Following 4 weeks of sham stimulation, all patients then initially received 24 weeks of actual DBS. Following this period of actual DBS, active stimulation of the deep brain electrodes was then temporarily stopped. (Once again, this discontinuation of active DBS was not revealed to the patients.) These patient volunteers were then treated with DBS and monitored for up to 2 years.
In this group of patients who had previously failed, literally, all other forms of conventional therapy for their severe depression, DBS was associated with complete remission of depression in 18 percent (3) of the patients, and a significant improvement in depressive symptoms was observed in 41 percent (7) of the patients after 24 weeks of active DBS. After 2 years of active DBS, 12 patients remained in the study, and 92 percent (11) of these patients experienced significant improvement in their depressive symptoms, including 58 percent (7) who experienced a complete remission of their depression!
The findings of this small prospective, controlled clinical research study are both dramatic and important, and for several reasons. First of all, the clinically significant improvement seen in almost all of these patients is extraordinary in view of the severity of their depression and the completely refractory nature of their depressive symptoms. Secondly this study included several patients with bipolar disorder, a disease which is characterized by alternating episodes of mania (a state of extreme mental and physical hyperactivity) and depression. (Earlier studies of DBS had suggested that this treatment might not be as effective in patients with bipolar disorder, and might also lead to an increased risk of episodes of mania. However, in this small pilot study, DBS was as effective in treating the symptoms of depression in patients with bipolar disorder as it was in patients with depression alone. Moreover, DBS did not appear to increase the likelihood of episodes of mania in patients with bipolar disorder.)
Depression is a common mental health disorder, and severe cases of depression can leave patients feeling miserable and hopeless. In especially severe cases, depressed patients may be unable to function in their daily personal or professional lives. For some unfortunate patients with depression, suicide or accidental causes of death may also end their lives prematurely. Based upon the findings of this small, preliminary clinical study, DBS may be a safe and effective treatment option for patients with chronic, severe, and refractory depression.
If you are depressed, and you are having thoughts about harming yourself (or harming someone else), please immediately contact your mental health provider, a suicide hotline, your personal physician, a close and trusted friend or relative, or your clergy person. Even during times when you feel like there is no hope that life will get better for you, it almost always will get better if you get some help.
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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