Pacemaker for the brain can treat depression

Implant provides immediate, long-term relief of patient’s symptoms

Severe depression can be treated using pacemaker-style device for the brain, a study has found.

The surgical implant alleviates suicidal thoughts, scientists said.

They successfully treated a patient by tapping into the specific brain circuit involved in depressive brain patterns and reset them using the instrument.

“I was at the end of the line,” said the patient, who asked to be identified by only her first name, Sarah. “I was severely depressed. I could not see myself continuing if this was all I’d be able to do, if I could never move beyond this. It was not a life worth living.”

Researchers say the findings are a breakthrough in the years-long effort to apply advances in neuroscience to the treatment of psychiatric disorders.

They say the proof-of-concept study reveals how brain activity may be monitored to deliver personalised treatment for mental health conditions.

“This study points the way to a new paradigm that is desperately needed in psychiatry,” said Prof Andrew Krystal, professor of psychiatry and member of the University of California San Francisco Weill Institute for Neurosciences.

“We’ve developed a precision-medicine approach that has successfully managed our patient’s treatment-resistant depression by identifying and modulating the circuit in her brain that’s uniquely associated with her symptoms.”

Previous studies have found limited success for treating depression with traditional deep brain stimulation.

Researchers suggest this is partly because most devices can deliver only constant electrical stimulation, usually in one area of the brain.

What made the new trial successful was the discovery of a neural biomarker – a specific pattern of brain activity that indicates the onset of symptoms.

The team customised a new DBS device to respond only when it recognised that pattern.

The device then stimulated a different area of the brain circuit, creating on-demand, immediate therapy that was unique to both the patient’s brain and the neural circuit causing their illness.

First author Dr Katherine Scangos, a member of the Weill Institute, said: “We were able to deliver this customised treatment to a patient with depression, and it alleviated her symptoms.

“We haven’t been able to do this kind of personalised therapy previously in psychiatry.”

Prof Krystal said the immediate effect was in contrast to the four to eight-week delay of standard treatment models.

It has also lasted for the 15 months since the device was implanted.

Sarah says the past year has offered an opportunity for real progress after years of failed treatments.

“In the early few months, the lessening of the depression was so abrupt, and I wasn’t sure if it would last,” she said. “But it has lasted. And I’ve come to realise that the device really augments the therapy and self-care I’ve learned while being a patient here at UCSF.”

The combination has given her perspective on emotional triggers and irrational thoughts on which she used to obsess. “Now,” she said, “those thoughts still come up, but it’s just … puff … the cycle stops.”

For patients with long-term, treatment-resistant depression, that result could be transformative, researchers said.

The scientists said further research would be needed to determine whether these results can be generalised to a broader population.

Their study is published in Nature Medicine.

Updated: October 5th 2021, 6:31 AM
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