A woman successfully treats depression with an electrical brain implant | depression

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A severely depressed woman has been successfully treated with an experimental brain implant in an “amazing” advance that offers hope to those with incurable mental illness.

The device works by detecting patterns of brain activity associated with depression and automatically interrupting them using small pulses of electrical stimulation delivered deep inside the brain.

Sarah, the 36-year-old patient, said the treatment brought her back to a “life worth living,” allowing her to laugh spontaneously for the first time in five years.

Although the treatment has only been tested on one patient – and would only be suitable for those with severe disease – the success is seen as very important. It is the first evidence that the brain activity underlying symptoms of mental illness can be reliably detected and reveals that these brain circuits can be pushed back into a healthy state, even in a patient who has been unwell for years.

“We haven’t been able to do this kind of personalized therapy previously in psychiatry,” said Catherine Skangos, assistant professor of clinical psychiatry at the University of California, San Francisco (UCSF), who led the work. “This success in itself is an amazing advance in our knowledge of the brain function that underlies mental illness.”

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Professor Robert McShane, consultant psychiatrist and associate professor at the University of Oxford, who was not involved in the trial, said: “This is an astonishing display…that suggests a way to examine the biology of a sudden decline in despair that can be so devastating.”

Between 10% and 30% of people with depression do not respond to at least two drug treatments – equivalent to around 2.7 million people in the UK.

Over the past two decades, deep brain stimulation (DBS) has been used to treat tens of thousands of patients with Parkinson’s disease and epilepsy. However, many depression experiences ended in disappointment. The main challenge is that the brain does not appear to have a single “depression zone”; It can play several interconnected areas and can vary between people.

“We are beginning to learn about some of the complexities involved in how moods are organized in the brain as a network,” said Professor Edward Chang of the University of California, San Francisco, the neurosurgeon who treated Sarah.

A careful and personalized approach paved the way for the latest advances. In an initial week-long phase, a temporary brain implant recorded a wide range of activity while Sarah regularly recorded her mood on a tablet. A machine learning algorithm was used to identify an alarm pattern of activity in the amygdala associated with the lowest pleasant score.

Through trial and error, scientists have identified a closely related brain region, the ventral striatum, where a small dose of electricity appears to have an immediate and profound effect.

“When I first received the stimulation, I felt the most joyous and my depression was an unattainable nightmare for a moment,” Sarah said. “I just laughed out loud. It’s the first time I’ve laughed or smiled spontaneously… in five years.”

In the second round of minimally invasive surgery, a permanent device, with a small battery module built into her skull, was implanted to detect “depression signature” activity in the amygdala and automatically deliver the stimulation to the ventral striatum.

This happens about 300 times each day, which equates to about 30 minutes of stimulation. Sarah said that the electrical pulse is not accompanied by any sensation other than a hidden feeling of alertness and positivity.

“The idea that we can treat symptoms right now, when they arise, is an entirely new way to treat even the most difficult to treat depression,” Skangos said. She hopes the work will also help remove the stigma that “comes from the black box nature” of depression.

Sarah described a life before treatment in which she could barely move, no longer had opinions and “just noticed what’s ugly in the world.” After five years of suffering, treatment options have run out. The profound impact of the transplant assured her that her depression was rooted in brain biology and that it was “not a moral failure, but a treatable disorder.”

The device costs around $35,000 (£26 000) and is a modified version of a device commonly used to treat epilepsy, called the NeuroPace RNS System. The UCSF team has already enrolled two more patients and hopes to recruit nine more to assess whether the technique can be applied more widely.

Professor Elaine Joyce, Professor of Neuropsychiatry at University College London, who is leading a trial using deep brain stimulation for OCD, said: “The results are real and important. It’s a fascinating piece of translational clinical neuroscience. I’m not sure anyone else in the world does that in right now, but I’m sure they will do it in the future.”

While the method won’t be widely or immediately applied, McShane said, “if I was a medical student thinking about any field that would show exciting developments during my working life, that would be a reason to consider psychiatry.” The results were published in the journal Nature Medicine.

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