Brain stimulation acts “like a switch” to turn off severe depression in one patient

“I’ve run out of all possible treatment options, but I haven’t succeeded in getting rid of the depression that fell five years ago,” Sarah told reporters.

“My daily life was very limited by depression, I was poor, I was tortured every day, and I was forced to resist the suicide urge to overtake me several times an hour. When I was first stimulated. , I felt the strongest sense of joy, “she added.

“And my depression was a distant nightmare for a moment.”

The research team worked diligently with Sarah to first map the areas of her brain that became active when she experienced the worst symptoms of depression. They implanted two small wires in her brain to detect related brain activity and send a pulse of electricity to block the signal.

But it offers some little hope for people with the most severe and refractory depression, who cannot be helped by cognitive therapy, drugs, or even electroconvulsive shock therapy, the team said.

“To identify the patient’s own depression circuit, we placed temporary electrodes, which are very thin wires, in the brain region associated with the mood of the depressed patient. Then, a small stimulus pulse was placed throughout the region. Send them one by one and the patient’s clinical response. “

Precision mapping

However, Scangos and her colleagues said the difference between their approaches was the careful mapping of Sarah’s specific brain activity and the calibration of the device to respond to changes in the signal.

“There is no area of ​​depression or area of ​​mood in the brain,” said Dr. Edward Chan, a UCSF neurosurgeon who was a member of the research team.

In Sarah’s case, signals from the amygdala, a small emotion-related structure in the brain, predicted her worst symptoms. Chang et al. Adopted a commercial device approved by the US Food and Drug Administration to treat severe epilepsy.

“This gives us unprecedented accuracy in treating depression. This is the first demonstration of personalization,” said Chan.

“The exact mechanism by which it treats symptoms is unknown,” he added. The team came up with the idea when they saw evidence that people being treated for epilepsy with this device often reported that their use improved their symptoms of depression.

“This does not demonstrate the effectiveness of this approach. Much work has been done before us as an area to validate these results and see if this is a permanent treatment option. There is, “said Mr. Chan.

Sarah is currently permanently embedding the device. According to Chan, a small piece of her skull was removed to accommodate a device about the size of a matchbook.

According to Scangos, Sarah turns the stimulus on and off for about 30 minutes a day to control her symptoms. She said the device’s battery should last about 10 years at this utilization. “We titrated the stimulus so she couldn’t detect it,” Scangos said.

According to Scangos and Chang, such an approach applies only to the most serious cases.

“It was so serious that I had no idea if she could treat her depression,” Scangos said.

“This is what we call minimally invasive, but it’s surgery and there is a risk,” Chan added.

“This feeling of joy hit me.”

For Sarah, the impact was worth the risk. “Any kind of release would have been better than what I was experiencing,” she said. “Depression dominated my life. I didn’t move much. I did almost nothing.”

“I just laughed out loud,” Sarah said when the team first tried to stimulate after mapping her brain.

“It was the first time I had voluntarily laughed or laughed in a non-counterfeit place, and it wasn’t forced for five years,” she added. “This fun feeling hit me.”

Significant adjustments were required to ensure that the stimulus was felt seamlessly and that the effect lasted for more than a few minutes.

“At first, suicidal ideation disappeared within a few weeks, and then it was just a step-by-step process, as if my lens in the world had changed,” Sarah said.

“Everything has become easier and easier.”

One day, it stays in her heart. “I remember going home when the device was first turned on. I could see where the bay and swamp met. I remember being a god, like the difference in color. It’s gorgeous. It’s light. “Sara’s symptoms of depression made the world look gray and uninteresting.

Not a moral failure

“By the end of this, I said what it was. This is no different than a person with Parkinson’s disease,” Sarah said.

“No one tells people with Parkinson’s disease that if you put up with a positive attitude, you’ll be cured yourself.” No one says this to people with cancer, “she added. But she said people didn’t treat depression as an illness.

“The feedback we get from society is that it’s a moral failure. It must be wrong for you,” she said. “Even if it makes sense.”

Every time the treatment failed, she felt like a failure, Sarah said. “The stigma of depression is overwhelming,” she said.

According to NIMH, depression is characterized by persistent emptiness and guilt, loss of hope and energy, and other symptoms. “Depression is one of the most common mental illnesses in the United States. Current studies suggest that depression is caused by a combination of genetic, biological, environmental, and psychological factors.” Said NIMH.