Deep brain stimulation as a treatment for depression.

Health and medicine explained.
Feb. 19 2008 5:24 PM

Neurostimulation

Is it a good idea to drill holes in people's heads to treat them for depression?

Deep brain stimulation. Click image to expand.
Deep brain stimulation might help severely depressed patients

Doctors long have struggled over what to do with severely depressed patients who don't respond to treatment. Give them more medications that haven't worked so far? Recommend more talk therapy or another round of shock treatment?

Here's a new idea: open up a depressed head, find the brain parts that aren't working, and fix them with electricity. It's not all that far-fetched. Earlier this month, the Food and Drug Administration gave a medical device manufacturer the green light to recruit patients for a large-scale clinical trial of an electrode implanted deep inside the brain to alleviate severe depression. As invasive and Frankenstein-ish as it may seem, deep brain stimulation, as the method is called, may offer real hope for the 20 percent of depressed Americans whom Prozac can't help.

Advertisement

Anti-depressant drugs carpet-bomb the entire body. Electroconvulsive therapy jolts the whole brain. Deep brain stimulation aims to pinpoint the malady. Neurosurgeons drill through a patient's skull, place the DBS electrode's eight contact points directly on the trouble spots and connect them to an electrical current from a pacemaker embedded in the chest. This allows doctors to rev up sluggish areas or calm overactive regions.

DBS has been used for a decade to control symptoms of Parkinson's disease. Using it to treat depression poses a different challenge. While neurologists may have found the region of the brain that controls tremors, they haven't yet confirmed where those magic buttons are for mental illness. How do you isolate something as all-consuming as depression—the grief, irritability, self-defeating thoughts, and irregular interest in food, sex, and sleep—in a few millimeters of gray tissue?

Despite the obstacles, the results of small studies testing DBS on depressed patients are promising. For example, researchers are honing in on the region known as the subgenual cingulated, which scans show is overactive in the brains of depressed patients and subsides when they undergo ECT or take antidepressants. (The same area lights up when nondepressed people experience extreme sadness.) Critics caution that highlighted areas on a scan don't necessarily correspond to the loci of depression, yet early research shows that depressed patients feel better when the area is continually stimulated. One such study of brain implants, by Emory psychiatric neurologist Helen Mayberg, found striking and sustained improvement in four of six patients. They reported feeling suddenly calm, aware, and interested in social activities. Some talked more spontaneously, louder, and with more emotion. Others said the colors in the room became brighter and details were more vivid.

Another research team is targeting a different but nearby part of the brain—the network of nodes in the frontal lobe and base of the thalamus and basal ganglia, where emotion, attention, and anxiety are believed to converge. In a recent study for another device manufacturer, researchers from Brown University and Cleveland Clinic found that five of 10 patients treated with DBS between 2003 and 2006 showed a 50 percent reduction in the severity of their depression one year later. Patients said they had less anxiety, more energy, and felt more connected with themselves and people around them. One said simply, "The fog has lifted." The researchers are waiting for approval to start enrolling patients in a bigger trial later this year.

TODAY IN SLATE

Foreigners

More Than Scottish Pride

Scotland’s referendum isn’t about nationalism. It’s about a system that failed, and a new generation looking to take a chance on itself. 

iOS 8 Comes Out Today. Do Not Put It on Your iPhone 4S.

Why Greenland’s “Dark Snow” Should Worry You

Three Talented Actresses in Three Terrible New Shows

The Human Need to Find Connections in Everything

It’s the source of creativity and delusions. It can harm us more than it helps us.

Jurisprudence

Happy Constitution Day!

Too bad it’s almost certainly unconstitutional.

The Ungodly Horror of Having a Bug Crawl Into Your Ear and Scratch Away at Your Eardrum

My Father Was James Brown. I Watched Him Beat My Mother. Then I Married Someone Like Him.

  News & Politics
Weigel
Sept. 17 2014 12:02 PM Here It Is: The Flimsiest Campaign Attack Ad of 2014, Which Won’t Stop Running
  Business
Business Insider
Sept. 17 2014 1:36 PM Nate Silver Versus Princeton Professor: Who Has the Right Models?
  Life
Outward
Sept. 17 2014 1:59 PM Ask a Homo: Secret Ally Codes 
  Double X
The XX Factor
Sept. 17 2014 1:26 PM Hey CBS, Rihanna Is Exactly Who I Want to See on My TV Before NFL Games
  Slate Plus
Slate Fare
Sept. 17 2014 9:37 AM Is Slate Too Liberal?  A members-only open thread.
  Arts
Brow Beat
Sept. 17 2014 1:01 PM A Rare, Very Unusual Interview With Michael Jackson, Animated
  Technology
Future Tense
Sept. 17 2014 12:35 PM IOS 8 Comes Out Today. Do Not Put It on Your iPhone 4S.
  Health & Science
Bad Astronomy
Sept. 17 2014 11:18 AM A Bridge Across the Sky
  Sports
Sports Nut
Sept. 15 2014 9:05 PM Giving Up on Goodell How the NFL lost the trust of its most loyal reporters.