How Deep Brain Stimulation Helped Treat Severe Depression in Women

Doctors have succeeded in treating patients with severe depression by using a device that corresponds to a pacemaker in the brain to reset the brain circuits associated with the brain pattern of depression.

University of California (UCSF) Researchers have discovered neurobiomarkers, which are specific patterns of brain activity that indicate the development of depression in patients, and market them to recognize those patterns and electrically stimulate other specific areas of the brain. Customized device.

A team led by Catherine Scangos, an assistant professor of psychiatry at the Weil Neuroscience Institute at the University of California, San Francisco, has created an immediate, specific neural circuit that triggers the patient and her treatment by surgically implanting the device. Created an “on-demand” therapy. Resistant depression.

“This study points the way to a new paradigm that is urgently needed in psychiatry,” said Andrew Krystal, a professor of psychiatry and a member of the UCSF Weil Neuroscience Institute, from the university. Said in the press release. “We have developed a precision medicine approach to better manage patients with treatment-resistant depression by identifying and adjusting circuits in the brain that are uniquely associated with the patient’s symptoms.”

Team proof-of-concept research published in journal Nature Medicine.

The method adopted by the team is a type of deep brain stimulation (DBS) that has shown promising treatment for depression in clinical trials, but with little success. This may be because the markers in the brain that indicate the onset of depression vary from person to person.

While previous methods of DBS provide constant stimulation to one area of ​​the brain, the approach developed by the UCSF team suggests that depression in different people may be associated with different areas of the brain. Identify individual biomarkers, taking into account the fact that they are.

Crystal points out that by adopting this customized approach, the symptoms of depression in a 36-year-old woman who attends under the name Sarah were alleviated almost immediately. This relief lasted for 15 months when she received the implant.

Using electrodes implanted in the frontal cortex, the team mapped Sarah’s stimulus response over a 10-day period and matched her response to the stimulus to the symptom rating scale she filled out.

They found that certain changes in the amygdala region of the brain alleviated Sarah’s symptoms. When these changes did not occur, her depression did not relieve.

Next, the team transplanted the NeuroPace RNS (Responsive NeuroStimulation) system into the right hemisphere of Sarah’s brain, which constantly senses neural activity according to a pre-specified pattern. UCSF researchers also wirelessly collected a 10-minute data stream from Sarah’s brain during her daily activities.

One electrode lead from the device was placed in the area of ​​the brain where the biomarker was found, and the other was connected to another area of ​​Sarah’s brain where the team found that stimulation led to relaxation.

When the team-created closed loop sensed the biomarker in the first region, it applied only 1mA (1/1000 amps) of electricity to the second region for 6 seconds.

This altered Sarah’s neural activity, and researchers confirmed that changes in Sarah’s amygdala were actually associated with her depression.Applying their closed-loop stimulation method to this marker, Sarah’s condition Significantly.

“I was at the end of the line. I was terribly depressed,” Sarah said in a UCSF press release. “Even now, those ideas come to the fore, but it’s just … tired … the cycle stops.”

What the team cannot do with this trial is to determine if this individual treatment is effective for all patients. The team points out the limitations of this proof-of-concept study. Nature medicine paper.. In addition to pointing out that the sample size for this trial was 1, the team also pointed out that Sarah was unaware when the treatment was applied, but that they knew the treatment themselves. This can distort the results.

Following this successful proof-of-concept study, the team was able to test closed-loop neuromodulation in a much larger trial, and ultimately relief For many patients with long-term refractory depression, And other neuropsychiatric conditions that helped Sarah.

“There’s still a lot to do,” Scangos said in a press release. “We need to investigate how these circuits change between patients and repeat this process multiple times, and see if an individual’s biomarker or brain circuit changes over time as treatment continues. need to do it.”