Brain stimulation acts “like a switch” to turn off severe depression in a patient

“I had exhausted all possible treatment options without being able to resolve the depression that had plagued by five years earlier,” Sarah told reporters.

“My daily life had become so restricted and impoverished by depression that I felt tortured every day and forced myself to resist the suicidal impulses that overwhelmed me several times an hour. When I first received the stimulation, I was told. felt the most intensely joyful sensation. ”she added.

“And my depression was a distant nightmare for a while.”

The study team worked intensely with Sarah to first map the areas of her brain that became active when she was experiencing the worst symptoms of depression. They implanted two small wires in her brain to detect associated brain activity, then deliver an electrical impulse that interrupts the signal.

But it gives a little hope to people with the most severe and intractable forms of depression, which aren’t helped by cognitive therapy, drugs, or even electroconvulsive therapy, the team said.

“To identify a patient’s unique depression circuit, we placed temporary electrodes, which are really thin wires, in mood-related regions of the brain in patients with depression. And then we delivered small ones. Stimulus pulses through regions, one by one, and recorded clinical response, ”Scangos said.

Precision mapping

But Scangos and his colleagues said the difference in their approach was the careful mapping of Sarah’s particular brain activity and the calibration of the device to respond to changes in signaling.

“There isn’t a single area of ​​depression or a single area of ​​mood in the brain,” said UCSF neurosurgeon Dr. Edward Chang, a member of the study team.

In Sarah’s case, signals from the amygdala, a small structure in the brain associated with emotions, predicted her worst symptoms. Chang and his colleagues adapted a commercially available device approved by the US Food and Drug Administration for the treatment of severe epilepsy.

“This gives us a precision that we have never had before in the treatment of depression. This is our first demonstration of personalization,” Chang said.

“The exact mechanism of how it treats the symptoms is not clear,” he added. The team came up with the idea when they saw evidence that people treated for epilepsy with the device often reported that their depression symptoms were improved by its use.

“This is not a demonstration of the effectiveness of this approach. We have a lot of work ahead of us as an area to validate these results, to see if this is something that will endure as a treatment option.” Chang said.

Sarah has the device permanently implanted now. A small piece of his skull was removed to accommodate the device, which is about the size of a matchbox, Chang said.

Scangos said Sarah receives about 30 minutes of stimulation a day to control her symptoms. The device’s battery is expected to last around 10 years at this rate of use, she said. “We titled the stimulation so that she couldn’t detect it,” Scangos said,

Such an approach is only for the most severe cases, said Scangos and Chang.

“We had no idea at all if we were going to be able to treat his depression because it was so bad,” Scangos said.

“Even though it’s what we call a minimally invasive procedure, it’s surgery and it comes with risks,” Chang added.

“This happy feeling came over me”

For Sarah, the effects were worth the risks. “Any kind of release would have been better than what I was going through,” she said. “Depression was controlling my life. I barely moved. I was doing next to nothing.”

The first time the team tried the stimulation after mapping their brain, “I just burst out laughing,” Sarah said.

“It was the first time that I laughed and smiled spontaneously where it was not rigged, it was not forced, for five years,” she added. “This happy feeling washed over me.”

It took a considerable adjustment to make the stimulation feel seamless – and to make sure the effects last for more than a few minutes.

“At first, within a few weeks, the suicidal thoughts just disappeared. Then it was just a gradual process. It was like my focus on the world had changed,” Sarah said.

“Everything just got easier and easier and easier.”

One day remains etched in his mind. “I just remember coming home one of the first times the device was turned on. I could see the bay and where it met the swamps, and I remember being, god – like, the differentiation of colors. It’s beautiful – the light. ” Sarah’s symptoms of depression had made the world gray and uninteresting.

Not a moral fault

“At the end, I said oh my god – that’s no different from someone with Parkinson’s,” Sarah said.

“Nobody tells a person with Parkinson’s disease ‘if you just have a positive attitude and persevere you will heal yourself.” Nobody says that to someone who has cancer, ”she said. added. But people don’t treat depression as an illness, she said.

“The feedback we’re getting from society is that this is a moral failure. It must be something that you are doing wrong,” she said. “Even if it is well intentioned.”

Each failed treatment made her feel more like a failure, Sarah said. “The stigma of depression is overwhelming,” she said.

According to the NIMH, depression is characterized by a persistent feeling of emptiness and guilt, loss of hope and energy, and other symptoms. “Depression is one of the most common mental disorders in the United States. Current research suggests that depression is caused by a combination of genetic, biological, environmental and psychological factors,” says the NIMH.