For some people with difficult-to-treat depression, a personalised, implanted device for the brain might provide relief when nothing else can, a new case study published Monday suggests. Researchers claim, for the first time, to have used custom-fitted deep brain stimulation to substantially alleviate a patient’s decades-long bout with severe depression. Though there are many questions about the feasibility of this technology on a large scale, they hope this could turn out to be an incredible advancement in the field.
Deep brain stimulation, or DBS, is already successfully used to help manage neurological conditions including Parkinson’s disease and certain types of seizures. The concept behind DBS is to transmit electrical impulses to balance out the erratic patterns of brain activity associated with the target condition, hopefully eliminating or reducing the person’s symptoms. These impulses are sent out through electrodes implanted in the brain, regulated by a device typically implanted somewhere else in the body, much like how a heart pacemaker works.
DBS for depression has been a ripe area of study, since there do seem to be noticeable differences between the brains of people diagnosed with depression and those who are not. But so far, the evidence for its benefits has been inconsistent, with patients having varying responses to it. In recent years, scientists at the University of California, San Francisco have been working on ways to improve DBS, such as by finding possibly more relevant areas of the depressed brain to stimulate. Based on that earlier research, they’ve developed their own unique DBS technique, which they call personalised closed- loop neurostimulation.
In a new study published Monday in Nature Medicine, they detail how their method appears to have successfully treated a 36-year-old woman who had been living with depression since childhood. And at a press conference held late last week, the patient herself — identified as Sarah — testified to the almost instantaneous relief she experienced after starting the treatment.
“When I first received stimulation, the ‘aha’ moment occurred, I felt the most intensely joyous sensation, and my depression was a distant nightmare for a moment,” said Sarah, whose depression had become more severe in recent years, to the point where she felt constant suicidal ideation. “The expression made me realise that my depression was not a moral failing. It was a disorder that could be treated, and there was hope for my recovery.”
The method is said to work by first finding the specific brain activity patterns associated with a patient’s depressive state and then fine-tuning the impulses needed to counteract them. After that’s established, the patient is outfitted with a device that can detect when these moments of erratic brain activity show up and automatically send stimulation to the brain. This is in contrast to typical DBS, which involves sending impulses all the time or at fixed intervals of the day, like before bed. In Sarah’s case, the dysfunctional brain activity involved the ventral striatum, a crucial player in decision making, as well as the amygdala, an important regulator of our emotional response, particularly fear and anxiety.
The authors caution that this is only a single case and that Sarah’s experience should be only seen as a proof of concept. It will take more research to see if this treatment can be successfully replicated. Even if it can be, Sarah’s treatment took a lot of resources and time to calibrate — efforts that will make it hard right now for this technology to become widely available to patients with depression. Though the device itself is commercially available, the treatment would likely be expensive, with the researchers estimating a cost of about $41,151, based on existing costs for DBS.
“In order for this to help more people, it’s going to require simplification,” said study author and UCSF researcher Edward Chang in a response to a question from Gizmodo about the long-term future of this treatment. “But we also see a lot of opportunity for thinking about how technology, for example, can be used to help and minimise or reduce the amount of manual work and labour that’s required to do these really exhaustive analyses that were part of this trial.”
Study author and UCSF researcher Katherine Scangos said that the discoveries made by her team could pay off in other ways, even before this technology is able to be scaled up.
“We identified, through this trial, some fundamental properties about the brain — that the brain is understandable, that brain organisation and function can be reliably identified,” Scangos said. “And so we think these findings about the brain will be available to the general public and help us develop new personalised depression treatments, with a focus on brain circuits.”
Scangos’ colleagues are already studying if it’s possible to non-invasively stimulate the brain circuitry specifically associated with a person’s depression, she added.
As for Sarah, her symptoms of depression did start to return in the time between the first stimulation sessions and the implanting of the device. But once the device was implanted and turned on, Sarah again felt immense and continued relief — enough to finally apply the skills she had learned in therapy earlier, she said. Now a year into the treatment, she added, her depression remains at bay and she feels able to “rebuild a life worth living.”
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