A brain pacemaker helped a woman suffering from severe depression.It may soon give hope to others

new york – Emily Hollenbeck lived through repeated bouts of deep depression, which she likened to a black hole, where she felt gravity so strong that her limbs were so heavy that she could barely move. She knew that her disease could kill her. Both of her parents had taken their lives.

She was willing to try something extreme: having electrodes implanted in her brain as part of an treatment.

Researchers say the treatment, called deep brain stimulation (DBS), could ultimately help many of the nearly 3 million Americans with depression like hers who resist other treatments. states that it is possible. The drug has been approved for conditions such as Parkinson's disease and epilepsy, and many doctors and patients hope it will soon become widely available for depression.

This treatment delivers targeted electrical impulses to the patient, similar to a pacemaker in the brain. Recent research has been increasingly promising, and more studies are underway, but tentative progress has been made with his two large studies showing no benefit to using DBS for depression. has stopped, and some scientists continue to express concerns.

Meanwhile, the Food and Drug Administration agreed to accelerate its review of Abbott Laboratories' request to use a DBS device for treatment-resistant depression.

“I was surprised at first because the concept was so intense. It's like brain surgery. There are wires implanted in your brain,” said the scientist, who is participating in the ongoing research at Mount Sinai West. said Hollenbeck. “But at that point I felt like I had tried everything and was desperate for answers.”

Hollenbeck suffered from depression throughout her childhood, growing up in poverty and occasional homelessness. However, her first big game came during her college days after her father committed suicide in 2009. There was another bout during her tenure with Teach for America that left her nearly immobile, causing her to lose her job in the classroom and causing her to worry that she would fall back into poverty. She arrived at the hospital.

“It ended up being an on-and-off pattern,” she said. After responding to medication for a while, she relapsed.

Even after losing her mother during her final year of graduate school, she still managed to earn a doctorate in psychology. But the black hole always came back to pull her in. She said she sometimes considered ending her own life.

She said when her doctor told her about DBS three years ago, she had exhausted all options, including electroconvulsive therapy.

“Nothing else worked,” she said.

She became one of only a few hundred people to receive DBS treatment for depression.

Hollenbeck underwent brain surgery while sedated but awake. Dr. Brian Kopel, director of the Neuromodulation Center at Mount Sinai, placed thin metal electrodes in an area of ​​the brain called the subcallosal cingulate cortex, which regulates emotional behavior and is involved in feelings of sadness.

The electrodes are connected by internal wires to a device placed under the skin of her chest, which controls the amount of electrical stimulation and delivers constant low-voltage pulses. Hollenbeck calls it “continuous Prozac.”

Doctors argue that stimulation helps because electricity speaks the language of the brain. Neurons communicate using electrical and chemical signals.

In a normal brain, Kopel says, electrical activity bounces around unimpeded throughout the brain, creating a kind of dance. When depressed, dancers become trapped in the emotional circuitry of their brains. DBS appears to “unlock the circuits” and allow the brain to function normally, he said.

Hollenbeck said the effects were almost immediate.

“From the first day after surgery, she started to feel relief from that negative mood and heaviness,” said psychiatrist Dr. Martin Figge. “She enjoyed Vietnamese takeout for the first time in years and I remember her saying how delicious it was. She started decorating her home, which had been completely empty since she moved to New York.”

The biggest change for Hollenbeck was finding joy in music again.

“When I was depressed, I couldn't listen to music. It sounded and felt like I was listening to radio static,” she said. “And then, on a sunny summer day, I was walking down the street listening to a song. I felt a buoyancy that said, “Oh, I want to walk more, I want to go and do something!'' And I realized that I was getting better. ”

She just wishes she could have gotten therapy for her parents.

The path to this treatment dates back 20 years, when neurologist Dr. Helen Mayberg led promising initial research.

But setbacks continued. Large-scale studies begun more than a decade ago found no significant difference in response rates between treated and untreated groups. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, who also studies DBS and depression, points to the following reasons: The treatment was not individualized, and the researchers looked at the results over several weeks.

Several subsequent studies showed stable long-term relief from DBS when patients with depression were followed over a period of years. Overall, across a variety of brain targets, DBS for depression is associated with an average response rate of 60%, the 2022 study said.

The treatments being tested by different teams are now becoming more personalized. The team at Mount Sinai is one of the most prominent teams studying DBS for depression in the United States. There, neuroimaging experts are using brain images to determine exactly where Kopel will place the electrodes.

“We have a template, a blueprint of exactly where we want to go,” said Mayberg, a pioneer in DBS research and founding director of the Nash Family Center for Advanced Circuit Therapy at Mount Sinai. Ta. “Just as people's eyes are a little farther apart, or their noses are a little bigger or smaller, so too are their brains a little different.”

Other research teams are also tailoring treatments to patients, albeit using slightly different methods. Scangos and his colleagues are studying different targets in the brain and only stimulating them when necessary for severe symptoms. She said the best treatment may ultimately combine multiple approaches.

As the team continues its work, Abbott plans to begin large-scale clinical trials this year ahead of the FDA's decision.

“This field is progressing very rapidly,” Scangos says. “We hope to receive approval in the short term.”

But some doctors are skeptical, pointing to possible complications such as post-surgical bleeding, stroke and infection.

Dr. Stanley Caloff, professor emeritus of psychiatry at the University of Pennsylvania, said scientists still don't know the exact pathways and mechanisms in the brain that cause depression, making it difficult to choose which areas to stimulate. Ta. Selecting the right patients for DBS is also difficult, he said, and approved and successful treatments for depression are available.

“From a psychiatric perspective, I believe there is no science,” he said of DBS for depression.

Hollenbeck acknowledges that DBS is not a panacea. She still takes medication for depression and requires ongoing care.

She recently visited Mayburg's office to discuss her recovery. “It's not important to be happy all the time,” her doctor told her. “It's about progress.”

That's what researchers are currently studying: a way to track progress.

A recent study by Mayberg et al., published in the journal Nature, shows that it is possible to “read out” someone's behavior at a specific point in time. Researchers analyzing the brain activity of DBS patients found unique patterns that reflect the recovery process. This gives us an objective way to watch how people recover and distinguish between impending depression and typical mood swings.

Scientists are confirming these findings using the new DBS device in a group of patients, including Hollenbeck.

She and other participants primarily perform their roles from home. She regularly provides brain recordings to researchers by logging on to her tablet, placing a remote control over a pacemaker-like device on her chest, and transmitting data. She answers her questions that arise about her feelings. She then records a video that analyzes her facial expressions, speech, and more.

Occasionally, she enters the “Q-Lab” at Mount Sinai. There, scientists will conduct quantitative studies, collecting all kinds of data, such as how she moves in a virtual forest, how she draws circles in the air with her arms, and more. Like many of her patients, she now feels better and can move her arm faster.

Data from records and visits is combined with other information such as life events to create a graph of how she is doing. This guides decisions doctors once made, such as whether to increase the dose of electricity.

On a recent morning, Hollenbach moved his collar and brushed aside his hair to reveal scars on his chest and head from DBS surgery. To her, they are a sign of how far she has come.

She wanders around the city, walks in parks, and goes to the library, which was her childhood refuge. She is not worried that her normal life difficulties will cause severe depression.

“The stress can be pretty extreme at times, but I can check in and remind myself that I'm okay, even on a physical level,” she said.

“If it wasn't for DBS, I'm sure I wouldn't be alive today.”

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