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    Novel brain stimulation approach treats severe depression

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    John woke up, watched on the operating table, and was conscious during the brain surgery. But he wasn’t suffering. In fact, he says, “it seemed like I was suddenly back online.”

    John suffers from treatment resistance depression (TRD) was the first person to participate in a clinical trial to treat TRD using deep brain stimulation (DBS), Dr. Sameer Sheth, Associate Professor of Neurosurgery, Cullen Foundation Endowed Chair, and Baylor College of Medicine. Is led by McNair Scholar. Dr. Wayne Goodman, Professor and Chairman of the Meninger Department of Psychiatry and Behavioral Sciences in Baylor, and Dr. Nader Poulatian, Professor of Neurosurgery at the UT Southwestern Medical Center.

    The patient wakes up during surgery because the electrical leads are embedded in the brain. This procedure uses a first-time approach that incorporates intracranial EEG recording and stimulation to personalize an understanding of the brain’s network behavior and response to DBS devices during depression.The survey results are published at Biological psychiatry..

    “I was in the midst of a five-year depression episode, although I tried several different treatments and medications, including those that worked for me in the past and some new ones. This time there was no difference, “he said. Said. “Depression was nothing new to my life. This is something I have to control as I have tried to commit suicide in my past depression and have been in a coma for some time. I found out. “

    John began looking for options online and came across several articles that eventually led to Baylor.

    “The goal of our research is to find a way to personalize the treatment. No two people have the same experience of depression. It can produce different behaviors, thoughts and feelings from person to person. The difference between these experiences is the pattern of brain activity. ” “Using DBS and intracranial EEG readings, we were able to show that we can individually understand specific brain networks that contribute to a patient’s specific depressive symptoms and identify the optimal stimulation pattern for that patient. . “

    John explained that he feels like he can think more clearly on the operating table. electrode If ported and tested, the process of fine-tuning the device can take months. He stayed in the hospital for 10 days for a series of tests, and over the next few weeks to months, researchers continued to program and tune the device. John said it took about four months to be considered in remission from depression.

    “As a psychiatrist who performed DBS programming, the stimulus settings selected during this research study differ from those selected solely based on my clinical experience of programming,” says Goodman. .. “A great achievement for this person is to encourage the news that DBS can be personalized based on their unique brain activity patterns.”

    Such procedures may be affected by the placebo effect, an improvement in symptoms unrelated to DBS therapy. “Patients want to feel better, so they may actually feel better regardless of the stimulus. To confirm that the improvement is due to DBS, the amount of stimulus in the double-blind phase of the study. He slowly reduced. His symptoms worsened. At this stage, he proved that the DBS was actually causing the improvement. Returning the system to full power again alleviated the symptoms. ” Sheth said.

    DBS works by sending electrical signals to areas of the brain where electrodes are embedded. It is most commonly used for movement disorders such as Parkinson’s disease. To reduce the motor symptoms of Parkinson’s disease, signals help restore balance in the motor-regulated areas of the brain.

    Collaborators from Sheth, Goodman, and Pouratian at Brown University, University of Pittsburgh, and Case Western Reserve University have developed a way to use this technology for TRD. Using DBS, they could not only signal to the brain, but for the first time combine this with direct recording from the brain. In other words, we were able to record brain activity and stimulate the brain at the same time.

    They focused on two areas known to be involved in depressive symptoms: the subcallosal area (SCC) and the ventral capsule / ventral striatum (VC / VS) area of ​​the brain.

    “These DBS targets are thought to be the hub of the crossroads of important white matter pathways that connect the cortex and subcortical network regions associated with the development of depressive symptoms,” said Pouratian. “SCC stimuli more often reduce negative emotions, and VC / VS stimuli usually increase positive emotions. This is the first study to cover both areas at the same time. By doing so, depression You will have more control over your symptoms. Adjust your DBS to suit your individual patient’s needs. “

    During the first 10 days in the hospital, researchers were able to see how John’s brain activity patterns look in different mood states. These various mood states arose from natural changes, but were also caused, for example, by watching a video clip containing happy or sad content. The next step was to provide a stimulus to identify settings that produced activity patterns that were closer to a healthier state.

    “We applied hundreds of different DBS stimulation patterns to see how each affected John’s brain activity. Next, we examined the data to best affect his brain’s happy or non-depressive patterns. We picked out a combination of similar stimuli, “said Dr. Kelly R. Bijanki, an assistant professor of neurosurgery at Baylor. “It wasn’t entirely dependent on how the stimulus made John feel at that moment, because it doesn’t always predict how he will feel later. Emotional reaction. The stimulus patterns that cause Or it turned out that they predicted they would start a few months later. “Certainly, that was John’s case, and he experienced a steady improvement in his symptoms over the next few weeks.

    The Principal Investigator emphasizes that the reaction to the device can vary from person to person. Others may take longer to get a positive response, but may only need minor adjustments to reach a healthy state. A total of 12 participants will be enrolled in both Baylor and UT Southwestern. Each participant has a different set of optimal stimulation patterns for them. That’s one of the reasons why John finds it difficult to explain his depression to others. Everyone can have a unique experience.

    “It’s basically horror. I can’t think straight, I can’t sleep, I’m anxious. I didn’t have the energy and I didn’t have any joy. This isn’t a weakness. It’s an error to feed back to you because your brain is literally dysfunctional and misfired. It’s a brain disease, “said John.

    He explains that these functions in a healthy brain occur regularly in a way that is appropriate when people deal with life. However, for people with depression, the effort to take simple actions can be too much to handle.

    “When you get depressed, you lose that control over your life,” John said. “It took me a while to reach a healthy baseline again after the implant was inserted, but today I feel it’s even better than before the first episode of depression 10 years ago. I am. “

    John keeps what looks like a TV remote control in his home office, which has the ability to control stimuli. He uses it in collaboration with a doctor during a programming session. brain The activity will be reviewed and researched.

    “John is generally a very analytical person and his career contains a lot of technical know-how, so it seems that the level of analytic thinking has changed from 3 to 9 on a 10 scale. When he says he feels, the change is obvious. I’m working for him. “

    As John’s participation in the study continues, he returns to what he says is his usual routine at work. At home, his family recently had a new baby.

    “It takes a lot of time to become a person,” John said. “When I was depressed, I was in the oven and just wanted to get out of the fire. I didn’t care. Now I can feel the joy of life and be me again.”

    Others who have contributed to this study include Dr. Brian Metsger, Anusha Arawara, Victoria Piltor, Dr. Josh A. Adkinson, Dr. John Myers, Dr. Lyssa K. Mathura, Dr. Dennis Oswald, and Evangelia. Includes Dr. Zoraki, Jiayan Xiao and Angela. Dr. Noecker, Dr. Adriana M. Strutt, Dr. Jeffrey F. Cohn, Dr. Cameron C. McIntyre, Dr. Sanjay J. Mathew, Dr. David Borton.

    “Personalized” brain zap may relieve difficult-to-treat depression

    For more information:
    Sameer A. Sheth et al, Deep Brain Stimulation Therapy for Depression Informed by Intracranial Recording, Biological psychiatry (2021). DOI: 10.1016 / j.biopsych.2021.11.007

    Quote: A new brain stimulation approach was taken from on November 22, 2021 for severe depression (November 2021). 22 days) will be treated

    This document is subject to copyright. No part may be reproduced without written permission, except for fair transactions for personal investigation or research purposes. Content is provided for informational purposes only.

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