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Thursday, October 28, 2021

Brain implant may lift most severe depression


An electrical implant that sits in the skull and is wired to the brain can detect and treat severe depression, US scientists believe after promising results with a first patient.

Sarah, who is 36, had the device fitted more than a year ago and says it has turned her life around.

The matchbox-sized pack in her head is always “on” but only delivers an impulse when it senses she may need it.

The experimental study is described in Nature Medicine journal.

The researchers, from University of California, San Francisco, stress it is too soon to say if it might help other patients, like Sarah, with hard-to-treat depression, but they are hopeful and plan more trials.

Depression circuits

Sarah is the first person to receive the experimental treatment.

She’d had a string of failed treatments in recent years, including antidepressants and electroconvulsive therapy.

The surgery may appear intimidating, but Sarah stated that the prospect of “any kind of relief” was preferable to the darkness she had been experiencing.

“I had exhausted all treatment options.”

“My day-to-day life had become so constrained. Every day was torture for me. “I didn’t move or do anything.”

Drilling small holes in her skull to accommodate the wires that would monitor and stimulate her brain was part of the procedure.

The box containing the battery and the pulse generator was tucked beneath her scalp and hair, beneath the bone.

Sarah was unconscious throughout the procedure, which took a full working day and was performed under general anaesthesia.

Sarah claims that when she awoke, she felt euphoric.

“When I first turned on the implant, my life took an immediate upward turn.” My life had returned to normal.

“The suicidal thoughts vanished within a few weeks.”

“When I was depressed, all I could see was what was ugly.”

Sarah is still doing well a year later, with no side effects.

“The device has kept my depression at bay, allowing me to rediscover myself and rebuild a life worth living.”

She can’t feel the device as it fires, but she says, “I could probably tell you within 15 minutes that it went off because of a sense of alertness and energy or the positivity I’ll feel.”

How it works

Dr. Katherine Scangos, a psychiatrist at the university, explained that the breakthrough was made possible by locating the “depression circuits” in Sarah’s brain.

“We discovered one location, called the ventral striatum, where stimulation consistently eliminated her feelings of depression.” “We also discovered a brain activity area in the amygdala that could predict when her symptoms were most severe.”

According to the researchers, much more research is needed to put the experimental therapy to the test and see if it can help more people suffering from severe depression, as well as other conditions.

Personalised treatment

“We need to look at how these circuits vary across patients and repeat this work multiple times,” said Dr Scangos, who has enrolled two other patients in the trial and hopes to recruit nine more. And we need to see if a person’s biomarker or brain circuit changes over time as the treatment progresses.” We weren’t sure if we’d be able to treat her depression at all because it was so severe.

“As a result, we are very excited about this. It’s desperately needed in the field right now.”

According to Dr. Edward Chang, the neurosurgeon who installed the device: “To be clear, this is not a demonstration of the effectiveness of this method.

“This is really just the first demonstration of this working in someone, and we have a lot of work ahead of us as a field to validate these results to see if this is something that will last as a treatment option.”

Prof Jonathan Roiser, a neuroscientist at the University College London in the United Kingdom, stated: “Although this type of highly invasive surgical procedure would only be used in the most severe patients with intractable symptoms, it is an exciting step forward because of the individualised nature of the stimulation.

“If tested on other patients, it is likely that different recording and stimulation sites would be required, as the precise brain circuitry underlying symptoms varies between individuals.

“Because there was only one patient and no control condition, it remains to be seen whether these promising results will be replicated in clinical trials.”

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