Researchers from the Medical Center — University of Freiburg and the University Hospital Bonn have recently shown deep brain stimulation to be effective in treating severe, drug-resistant depression. These results were observed to not only cause an acute effect, but to sustain long-term results in the patients as well. Published in the Nature journal Neuropsychopharmacology, the study describes use of thin electrodes to stimulate deep regions of the ‘reward system’ in 16 patients’ brains. Overall, significant reduction in ratings of depression severity was observed in all patients.
“The most compelling outcome from the study is the sustained efficacy in very severely ill patients,” said group leader Dr. Thomas Schläpfer, professor and head of the Division of Interventional Biological Psychiatry at the Medical Center — University of Freiburg.
Alongside Schläpfer was Prof. Dr. Volker A. Coenen, the study’s first author, and director of the Stereotactic and Functional Neurosurgery Unit at the Department of Neurosurgery of the Medical Center — University of Freiburg.
“Most treatments in psychiatry cease to be efficacious after months and years, we demonstrated for the first time in demonstrating in a relatively large-scale study that deep brain stimulation is a real option for those patients suffering from treatment-resistant, severe depression.”
It is estimated that 10-30% of patients diagnosed with recurrent depression show no response to currently approved treatments. With a need for new treatment options being eminent, deep brain stimulation offers a potential new avenue for these patients.
Synopsis of the Study
16 participants were involved in the FORSEE-II study, all of whom suffering from severe depression for 8-22 years. These patients also had each underwent 18 drug therapies, 70 hours of psychotherapy, and 20 electroconvulsive therapies on average, with none of these treatments having success.
Coenen and his team implanted deep brain stimulation systems into the medial forebrain bundle of the patient’s brains to apply controlled impulses. This specific region of the brain is associated with perceiving and regulating pleasure and reward, therefore having a large impact in the perceived quality of life.
The treatment’s efficacy was evaluated monthly via the Montgomery-Asberg Depression Rating Scale (MADRS). MADRS scores of most of the participants (10 of the 16) had decreased significantly within the first week of the study and remained at this lower level for the remainder.
All other patients were observed to react to the stimulation over the course of the study as well, with the average MADRS scores decreasing from the baseline of 29.6 to 12.9 in the 12-month duration of deep brain stimulation. Additionally, with eight of the 16 participants having MADRS scores under 10 points at the end, half of the participants were deemed to no longer be depressed.
“Our patients had struggled with severe depression for years with no signs of improvement,” said Schläpfer. “Deep brain stimulation brought most of them significant relief within days, which lasted throughout the course of the therapy. Other forms of treatment like medication and psychotherapy often lose their effectiveness over the course of time. Absolutely sensational about the study data is that the effect seems to be long lasting, with the positive effects continuing for years.”
The Freiburg researchers are currently conducting their third study using the technology. This study will involve treatment of 50 severely depressed patients, with 15 of them having already been operated upon.
“We know from a pilot study that the stimulation of this brain region is very promising, and we are delighted about the replication of these significant effects,” said Coenen.
Deep brain stimulation in the brain’s reward system shows excellent results over one year in 16 patients with previously therapy-resistant #depression. Results published by @Uniklinik_Fr researchers in Neuropsychopharmacology. https://t.co/d5Qo2olaZF
— Uniklinik Freiburg (@Uniklinik_Fr) March 19, 2019
Sources: Science Daily