Deep brain stimulation: An experimental depression treatment

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Deep brain stimulation: An experimental depression treatment

Deep brain stimulation — Learn about this experimental depression treatment.

Depression is usually a very treatable condition. Often, standard treatment with antidepressant medications, psychotherapy or electroconvulsive therapy can help improve even severe cases of depression.

But if standard depression treatment doesn't work, you might wonder if experimental treatment can help. One potential option is deep brain stimulation. This procedure hasn't been approved by the Food and Drug Administration (FDA) to treat depression, but it may be available to you through a clinical trial.

How deep brain stimulation works

Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. The procedure hasn't been FDA approved for depression and is in only the early stages of research. However, deep brain stimulation has become a standard treatment for people with Parkinson's disease.

Deep brain stimulation requires two surgical procedures — surgery on your brain to implant electrodes and surgery on your chest to implant a neurostimulator device. Because the procedure is new and experimental for depression, it may not be performed exactly the same way everywhere.

In general, here's how surgery for deep brain stimulation works. For the brain surgery portion, you're given local anesthetics to numb the area being operated on. You remain awake and alert, however, so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated. Your head is placed in a special frame to keep it still during surgery. Two holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain.

During the second portion of surgery, the surgeon implants the neurostimulator in your chest. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated neurostimulator. The neurostimulator sends electrical signals along the wires to the electrodes, stimulating the brain.

The neurostimulator can be easily programmed from outside your body. Dosage of the electrical impulses is customized to the individual. Stimulation is generally continuous, 24 hours a day.

How deep brain stimulation affects depression

Exactly how deep brain stimulation can affect depression isn't clear. Researchers theorize that certain regions deep within the brain influence mood and depression. They believe that the areas associated with depression may be overactive in certain people. Sending electrical impulses to these areas may "reset" them to normal functioning, researchers speculate.

Little research has been done using deep brain stimulation in people with depression. One clinical trial included just six people, for instance. Follow-up of these people has been short, which means it's not known if any improvements in depression symptoms will last long term. Additional research is needed to learn more about how deep brain stimulation works and how safe and effective it is for depression.

Who may benefit from deep brain stimulation

Because deep brain stimulation is experimental, it's available only through participation in clinical trials. In addition, because of the risks involved, its use is limited to people who have severe, debilitating depression that has not improved with other treatments. Talk to your doctor to see if it may be an option for you.

Side effects of deep brain stimulation

Any surgical procedure carries risks. Because deep brain stimulation involves brain surgery, the procedure may be especially risky. In addition, the neurostimulation itself may cause side effects.

Common side effects and adverse health problems associated with deep brain stimulation include:

  • Bleeding in the brain
  • Infection
  • Delirium
  • Unwanted mood changes
  • Movement disorders
  • Lightheadedness
  • Insomnia

In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.

The long-term risks of deep brain stimulation for depression aren't known.

There also are possible inconveniences associated with deep brain stimulation. For instance, the hardware may malfunction, and batteries must be replaced every one to three years.

Weighing the pros and cons of deep brain stimulation

Deep brain stimulation is a serious and potentially risky procedure. Even if you are a candidate for a clinical trial to test deep brain stimulation, you and your doctors must carefully weigh the pros and cons of the procedure. If your depression is incapacitating or life-threatening, you may be more willing to face the risks involved with deep brain stimulation.

Last Updated: 07/24/2006
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