Deep Brain Stimulation Shows Promise as Treatment for Treatment-Resistant Depression
Emily Hollenbeck, a woman who had been living with deep, recurring depression, likened her experience to being trapped in a black hole. She felt the weight of gravity pulling her down, making it difficult for her to move. With both of her parents having taken their own lives, Hollenbeck knew that her depression could be fatal. Desperate for a solution, she decided to try something extreme: deep brain stimulation (DBS).
DBS is an experimental therapy that involves implanting electrodes in the brain. While it is currently approved for conditions like Parkinson’s disease and epilepsy, researchers believe that it could also be an effective treatment for depression that does not respond to other therapies. The treatment delivers targeted electrical impulses to the brain, similar to a pacemaker. Recent research has shown promise, although there have been setbacks along the way.
Hollenbeck, who is participating in ongoing research at Mount Sinai West, initially had reservations about DBS. She described the concept as intense and invasive, considering that it involved brain surgery and the implantation of wires in her brain. However, after exhausting all other options, she felt desperate for a solution and was willing to take the risk.
Hollenbeck’s depression began in childhood due to poverty and occasional homelessness. It worsened after her father’s suicide in 2009 and during a teaching job with Teach for America. She found herself almost immobilized and feared losing her job and falling back into poverty. After trying various medications and therapies without success, she was introduced to DBS three years ago.
Dr. Brian Kopell, the director of Mount Sinai’s Center for Neuromodulation, performed the surgery on Hollenbeck. He placed thin metal electrodes in a region of her brain called the subcallosal cingulate cortex, which is involved in regulating emotional behavior and feelings of sadness. The electrodes are connected to a device implanted under the skin in her chest, which controls the electrical stimulation.
According to Hollenbeck’s psychiatrist, Dr. Martijn Figee, the effects of DBS were almost immediate. Hollenbeck experienced a lifting of her negative mood and heaviness, allowing her to enjoy things like food and music again. She described the treatment as “continuous Prozac.” For Hollenbeck, DBS has been life-changing, and she only wishes it had been available for her parents.
The road to DBS as a treatment for depression has been a long one. Dr. Helen Mayberg, a neurologist, conducted promising early research two decades ago. However, large studies conducted over a decade ago showed no significant difference in response rates between treated and untreated groups. This setback was attributed to the lack of personalization in the treatment and the short duration of the studies.
More recent research has shown that DBS can provide long-term relief from depression when observed over years. The average response rate for DBS in depression patients across different brain targets is around 60%. Treatment methods have become more tailored to individuals, with researchers using brain imaging to locate the precise spot for electrode placement.
Mount Sinai’s team is one of the leading research groups studying DBS for depression in the United States. Dr. Mayberg, a pioneer in DBS research, emphasizes the importance of individual differences in brain structure and function. Other research teams are also exploring different targets in the brain and delivering stimulation only when necessary for severe symptoms.
Despite the promising research, some doctors remain skeptical of DBS as a treatment for depression. They point out potential complications such as bleeding, stroke, or infection after surgery. Dr. Stanley Caroff, an emeritus professor of psychiatry, believes that the science behind DBS for depression is not yet fully understood. He also highlights the availability of approved and successful treatments for depression.
Hollenbeck acknowledges that DBS is not a cure-all and still requires ongoing care and medication. However, she has experienced significant improvements in her quality of life. She participates in research at Mount Sinai, providing regular brain recordings and answering questions about her mood and well-being. Researchers are using this data to track her progress and develop objective measures of improvement.
Recent research by Dr. Mayberg and others has shown that it is possible to analyze brain activity to determine how someone is doing at any given time. This provides an objective way to observe recovery and distinguish between impending depression and typical mood fluctuations. Scientists are confirming these findings using newer DBS devices in a group of patients, including Hollenbeck.
Hollenbeck’s journey with DBS has been transformative. She now enjoys activities like listening to music that were once impossible due to her depression. While there are still challenges, she feels a sense of hope and progress. DBS has given her a new lease on life, and she believes that without it, she would not be alive today.
The field of DBS for depression is advancing rapidly, with a big clinical trial set
