Deep Brain Stimulation: A Promising Treatment for Treatment-Resistant Depression
Emily Hollenbeck had lived with a debilitating depression for years, one that felt like a black hole sucking her in. She knew the gravity of her illness, as both her parents had tragically taken their own lives. Desperate for a solution, she decided to undergo an experimental therapy that involved having electrodes implanted in her brain. This treatment, known as deep brain stimulation (DBS), holds promise for the millions of Americans who suffer from depression that doesn’t respond to other treatments.
DBS is already approved for conditions like Parkinson’s disease and epilepsy, but its potential for treating depression is still being explored. The treatment involves delivering targeted electrical impulses to specific areas of the brain, much like a pacemaker. Although there have been setbacks in the research, with two large studies showing no advantage to using DBS for depression, progress is still being made. The Food and Drug Administration (FDA) has even agreed to expedite its review of Abbott Laboratories’ request to use DBS devices for treatment-resistant depression.
Hollenbeck’s journey with depression began in her childhood, growing up in poverty and occasional homelessness. She experienced her first major bout of depression after her father’s suicide in 2009. Despite responding to medication initially, she would always relapse. She pursued a doctorate in psychology, even after losing her mother during her last year of grad school. But the depression always returned, leading her to consider ending her life. After exhausting all other options, she was introduced to DBS three years ago.
The surgery involved implanting thin metal electrodes in Hollenbeck’s brain’s subcallosal cingulate cortex, a region involved in regulating emotional behavior and feelings of sadness. These electrodes were connected to a device placed under her skin, which controlled the electrical stimulation. According to Dr. Brian Kopell, who directed the surgery, DBS seems to “unstick the circuit” in the brain’s emotional circuitry, providing almost immediate relief for Hollenbeck.
The road to using DBS for depression has been a long one. Dr. Helen Mayberg, a neurologist, led early research into the treatment two decades ago. However, large studies conducted over a dozen years ago showed no significant difference in response rates between treated and untreated groups. Despite these setbacks, later research demonstrated that DBS could provide stable, long-term relief for depression patients. On average, DBS for depression is associated with response rates of 60%, according to a 2022 study.
Mount Sinai’s team is at the forefront of DBS research for depression in the United States. They use brain images to precisely locate the optimal spot for electrode placement. Other research teams also customize treatment methods, although there are concerns about potential complications such as bleeding, stroke, or infection after surgery. Some doctors remain skeptical, arguing that the science behind DBS for depression is still lacking.
For Hollenbeck, DBS hasn’t been a cure-all. She still takes medication for her depression and requires ongoing care. However, she has seen significant progress and improvement in her condition. Recent research by Dr. Mayberg and others has shown that it’s possible to track a patient’s progress using brain activity patterns. By analyzing the brain activity of DBS patients, researchers can observe their recovery process objectively and distinguish between impending depression and typical mood fluctuations.
Hollenbeck and other participants contribute to this research by providing regular brain recordings from the comfort of their homes. They log onto a tablet and place a remote above the device in their chest to record brain activity. They also answer questions about how they feel and record videos that are analyzed for facial expressions and speech patterns. Additionally, they visit Mount Sinai’s “Q-Lab” occasionally, where scientists collect various data points, including movement patterns in virtual environments. Hollenbeck, like many other patients, has noticed an improvement in her mobility and overall well-being.
As Hollenbeck brushes her hair aside to reveal the scars on her chest and head from the DBS surgery, she reflects on how far she has come. She can now enjoy walks in the park and visits to libraries, which were once a refuge during her difficult childhood. With DBS, she no longer fears that everyday challenges will trigger a debilitating depression. She firmly believes that without DBS, she wouldn’t be alive today.
While there are still skeptics and ongoing research, deep brain stimulation offers hope for those suffering from treatment-resistant depression. As scientists continue to study and refine the treatment, it may become a widely available option for millions of Americans who have exhausted all other options. The journey towards finding an effective treatment for depression is far from over, but DBS shines a light in the darkness for those who have been trapped in the grip of this debilitating illness.
