By Qasim Farrukh (Class of 2023)
Major depressive disorder (MDD) is a mental disorder that affects individuals on a global scale. With a 7% prevalence in the United States alone, it has serious implications for quality of life (Delaloye, 2014). Many common forms of treatment consist of psychotherapeutic methods such as cognitive behavioral therapy (CBT), as well as the usage of pharmaceutical drugs such as antidepressants. While these treatments have proven to be effective, only a third enter complete and sustained remission (Delaloye, 2014). As such, in more recent times, doctors, psychologists, and psychiatrists have collaborated to utilize deep brain stimulation (DBS) to combat severe depression. DBS involves a neurosurgical procedure to essentially install an electric “pacemaker” in the brain in order to provide continuous electrical stimulation that regulates the patient’s mood. Due to the efficacy of DBS, it is imperative to explore the science behind this procedure, how it combats major depressive disorder, and how this procedure can be made accessible to larger populations.
DBS is a minimally invasive procedure, and it essentially works in a similar format to a pacemaker, but it is used in the brain instead of the heart. To do this, doctors surgically place a small conductor, called an electrode, permanently in the brain. The electrode delivers a low-level impulse that aids in regulating mood for severe depression (Deep Brain Stimulation for Depression in Adults).
Once the electrode is implanted in the brain, the electrode targets discrete areas in the cingulate and prefrontal cortices. In this context, DBS targets the prefrontal cortex (PFC) because the PFC plays a major role in behaviors involving cognitive control and emotion processing (Kaya, 2019). The good thing about DBS, as opposed to traditional lesion surgeries, is that not only is DBS adjustable and non-destructive, but it is also reversible; thus providing a safety net for the patient. Once the device has been implanted, it can easily be switched on or off, allowing the patients’ healthcare team to study crossover effects within the individual themselves (Mosley et al., 2015). For patients with severe treatment-resistant depression (TRD), deep brain stimulation reduces depressive symptoms by approximately 40%-60% (Van der Wal et al., 2020).
It is important to note that DBS is a tried and tested method, and it is approved by the Food and Drug Administration (FDA), and that approval extends to treatment for various neurological and psychiatric disorders including, but not limited to: obsessive compulsive disorder (OCD), Parkinson’s disease, dystonia, and epilepsy. Furthermore, there are multidisciplinary committees that assess patients to make sure that deep brain stimulation would be safe and effective for them. For example, a patient is first referred to a neurologist who initially assesses the patient for surgery. The neurologist considers factors such as operative risks with regard to medical history and conducts various cognitive, memory, and psychological assessments of the patient. Last but not least, matters of ethics are also taken into consideration with guidelines that consistently emphasize that patients must be able to fully consent to their procedures, the safety and expected efficacy of treatment should be carefully studied before implementation, and that researchers must collaborate with other medical specialists to ensure patients are appropriately cared for before, during, and after a procedure (Anderson, 2019).
In essence, researchers are still looking into the long-term efficacy of deep brain stimulation (DBS) and the goal of science and research is to keep trying different methods until something eventually works! In the case of major depressive disorder with regard to treatment-resistant depression (TRD), scientists have found profound benefits of deep brain stimulation (DBS) and it is worthwhile to start looking into the accessibility and affordability of this treatment so that DBS be utilized from a holistic standpoint to cure those whose lives have been disproportionately affected by depression!
References:
Anderson, W. S., & Neurosurgery., T. S. for I. N. in. (2019). Deep Brain Stimulation: Techniques and practices. Thieme Medical Publishers.
Blomstedt, Sjöberg, R. L., Hansson, M., Bodlund, O., & Hariz, M. I. (2011). Deep brain stimulation in the treatment of depression: DBS for depression. Acta Psychiatrica Scandinavica, 123(1), 4–11. https://doi.org/10.1111/j.1600-0447.2010.01625.x
Conen, S., Matthews, J. C., Patel, N. K., Anton-Rodriguez, J., & Talbot, P. S. (2018). Acute and chronic changes in brain activity with deep brain stimulation for refractory depression. Journal of Psychopharmacology, 32(4), 430-440. doi:https://doi.org/10.1177/0269881117742668
Deep Brain Stimulation for Depression in Adults. (n.d.). NYU Langone Health. https://nyulangone.org/conditions/depression-in-adults/treatments/deep-brain-stimulation -for-depression-in-adults#:%7E:text=Deep%20brain%20stimulation%20works%20like,th at%20aids%20in%20regulating%20mood.
Delaloye, S., & Holtzheimer, P. E. (2014). Deep brain stimulation in the treatment of depression. Dialogues in clinical neuroscience, 16(1), 83–91. https://doi.org/10.31887/DCNS.2014.16.1/sdelaloye
Kaya, S., & McCabe, C. (2019). What Role Does the Prefrontal Cortex Play in the Processing of Negative and Positive Stimuli in Adolescent Depression?. Brain sciences, 9(5), 104. https://doi.org/10.3390/brainsci9050104
Mosley, E., Marsh, R., Carter, A. (2015). Deep brain stimulation for depression: Scientific issues and future directions. Australian & New Zealand Journal of Psychiatry, Vol. 49(11) 967–978. DOI: 10.1177/0004867415599845
Van der Wal JM, Bergfeld IO, Lok A, et al (2020). Long-term deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression. Journal of Neurology, Neurosurgery & Psychiatry; 91:189-195.
DBS is a minimally invasive procedure, and it essentially works in a similar format to a pacemaker, but it is used in the brain instead of the heart. To do this, doctors surgically place a small conductor, called an electrode, permanently in the brain. The electrode delivers a low-level impulse that aids in regulating mood for severe depression (Deep Brain Stimulation for Depression in Adults).
Once the electrode is implanted in the brain, the electrode targets discrete areas in the cingulate and prefrontal cortices. In this context, DBS targets the prefrontal cortex (PFC) because the PFC plays a major role in behaviors involving cognitive control and emotion processing (Kaya, 2019). The good thing about DBS, as opposed to traditional lesion surgeries, is that not only is DBS adjustable and non-destructive, but it is also reversible; thus providing a safety net for the patient. Once the device has been implanted, it can easily be switched on or off, allowing the patients’ healthcare team to study crossover effects within the individual themselves (Mosley et al., 2015). For patients with severe treatment-resistant depression (TRD), deep brain stimulation reduces depressive symptoms by approximately 40%-60% (Van der Wal et al., 2020).
It is important to note that DBS is a tried and tested method, and it is approved by the Food and Drug Administration (FDA), and that approval extends to treatment for various neurological and psychiatric disorders including, but not limited to: obsessive compulsive disorder (OCD), Parkinson’s disease, dystonia, and epilepsy. Furthermore, there are multidisciplinary committees that assess patients to make sure that deep brain stimulation would be safe and effective for them. For example, a patient is first referred to a neurologist who initially assesses the patient for surgery. The neurologist considers factors such as operative risks with regard to medical history and conducts various cognitive, memory, and psychological assessments of the patient. Last but not least, matters of ethics are also taken into consideration with guidelines that consistently emphasize that patients must be able to fully consent to their procedures, the safety and expected efficacy of treatment should be carefully studied before implementation, and that researchers must collaborate with other medical specialists to ensure patients are appropriately cared for before, during, and after a procedure (Anderson, 2019).
In essence, researchers are still looking into the long-term efficacy of deep brain stimulation (DBS) and the goal of science and research is to keep trying different methods until something eventually works! In the case of major depressive disorder with regard to treatment-resistant depression (TRD), scientists have found profound benefits of deep brain stimulation (DBS) and it is worthwhile to start looking into the accessibility and affordability of this treatment so that DBS be utilized from a holistic standpoint to cure those whose lives have been disproportionately affected by depression!
References:
Anderson, W. S., & Neurosurgery., T. S. for I. N. in. (2019). Deep Brain Stimulation: Techniques and practices. Thieme Medical Publishers.
Blomstedt, Sjöberg, R. L., Hansson, M., Bodlund, O., & Hariz, M. I. (2011). Deep brain stimulation in the treatment of depression: DBS for depression. Acta Psychiatrica Scandinavica, 123(1), 4–11. https://doi.org/10.1111/j.1600-0447.2010.01625.x
Conen, S., Matthews, J. C., Patel, N. K., Anton-Rodriguez, J., & Talbot, P. S. (2018). Acute and chronic changes in brain activity with deep brain stimulation for refractory depression. Journal of Psychopharmacology, 32(4), 430-440. doi:https://doi.org/10.1177/0269881117742668
Deep Brain Stimulation for Depression in Adults. (n.d.). NYU Langone Health. https://nyulangone.org/conditions/depression-in-adults/treatments/deep-brain-stimulation -for-depression-in-adults#:%7E:text=Deep%20brain%20stimulation%20works%20like,th at%20aids%20in%20regulating%20mood.
Delaloye, S., & Holtzheimer, P. E. (2014). Deep brain stimulation in the treatment of depression. Dialogues in clinical neuroscience, 16(1), 83–91. https://doi.org/10.31887/DCNS.2014.16.1/sdelaloye
Kaya, S., & McCabe, C. (2019). What Role Does the Prefrontal Cortex Play in the Processing of Negative and Positive Stimuli in Adolescent Depression?. Brain sciences, 9(5), 104. https://doi.org/10.3390/brainsci9050104
Mosley, E., Marsh, R., Carter, A. (2015). Deep brain stimulation for depression: Scientific issues and future directions. Australian & New Zealand Journal of Psychiatry, Vol. 49(11) 967–978. DOI: 10.1177/0004867415599845
Van der Wal JM, Bergfeld IO, Lok A, et al (2020). Long-term deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression. Journal of Neurology, Neurosurgery & Psychiatry; 91:189-195.
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