World Mental Health Day: brain implant a possible alternative to long-term medication

Surgically inserted device eliminates chronic depression in test case as world marks mental health day day

Four Emirati patients underwent the UAE's first deep brain stimulation operations. Photo: Cleveland Clinic Abu Dhabi

Brain implants to treat depression are being hailed as a “major step forward” in mental health care by UAE psychiatrists.

Surgeons hope implants could offer an alternative to long-term reliance on antidepressants, although research into the efficacy of deep brain stimulation at the University of California in San Francisco is still in the early stages.

This is a very significant piece of work, but these are early days, and this area requires more research

Dr Waleed Ahmed,
Priory Wellbeing Centre in Dubai and Abu Dhabi

Although semi-controlled in the UAE, pharmacies can supply up to 30 days of antidepressants at a time, and patients need to take the tablets daily for them to be effective.

Successful clinical trials of a surgical implant in a woman whose depression was resistant to medication offers hope that an alternative to drugs may soon be available.

Doctors in California successfully treated a female patient with severe depression by tapping into the specific brain circuit involved in depressive neural patterns.

Those markers were reset using a device similar to a pacemaker that corrects irregular heartbeats.

Neurologists said her symptoms were alleviated almost instantly, as opposed to the usual 4-8 weeks it would typically take under conventional treatment, and have lasted for 15 months.

It comes as people and medics mark World Mental Health Day on Sunday.

Dr Waleed Ahmed, a psychiatrist at the Priory Wellbeing Centre in Dubai and Abu Dhabi, said the breakthrough was significant.

“This is a very significant piece of work, but these are early days, and this area requires more research,” he said.

“Neuromodulation is an emerging and promising field of treatment for a few psychiatric conditions and its effectiveness depends upon the techniques used and the type of disorder being treated.”

Sophisticated electric shock treatment

The device is similar to electroconvulsive therapy (ECT), a procedure done under general anaesthesia in which small electric currents are passed through the brain, intentionally triggering a brief seizure.

The therapy causes changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

The treatment attracted criticism during early interventions when high doses of electricity were administered without anaesthesia, leading to serious side effects, including memory loss and bone fractures.

Because ECT is not an exact treatment, other non-relevant parts of the brain were occasionally affected, adding to the risks.

“This new treatment appears to be more exact, patient specific and tailor-made to the individual’s needs [than ECT],” Dr Ahmed said.

“Clearly, advances in techniques will improve the success rates of such new treatments and this work by UCSF is a major step forward.”

Rechargeable battery-powered devices can last up to nine years before they need to be replaced.

Although the US Food and Drug Administration has approved deep brain stimulation to treat movement and neurological disorders such as Parkinson’s disease and epilepsy, more research is required before it is signed off for wider use in cases of depression.

Earlier this year, four Emirati Parkinson's disease patients underwent DBS procedures at Cleveland Clinic Abu Dhabi.

The procedure typically costs between $30,000 and $50,000 and is often covered by health insurance.

Suitable candidates for DBS must be evaluated by a team of specialists, including a neurosurgeon, a neurologist and a psychiatrist.

A mental health epidemic?

A study by the University of Sharjah found that 57.2 per cent of people suffered at least one mental health disorder. Getty Images

In 2020, the global market for antidepressants was valued at about $26.25 billion.

Iceland, Portugal, Canada, Australia and the UK were the biggest consumers of antidepressants in 2019, according to research published by data analysts Statista.

Long-term use can be expensive, and reported side effects from the medication include anxiety, nausea, gastrointestinal problems, dizziness and insomnia.

A recent study by the University of Sharjah before the onset of the Covid-19 pandemic looked at how common mental health disorders were in the UAE.

Of the 700 participants, it found 57.2 per cent suffered from at least one complaint, with anxiety (56.4 per cent) and depression (31.5 per cent) the most common.

Women were found to be more likely to report a mental health concern than men, with 66.2 per cent reporting an improvement after visiting a trained specialist.

Carolyn Yaffe, a clinical psychologist at Medcare Camali Mental Health Clinic in Dubai, said the pandemic had created an uncertain future for many, often worsening existing mental health conditions.

“During this time of high stress and worry, people may not know what to do or how to process their experiences and feelings,” she said.

“This new way of life often brings an increase of stress, anxiety, depression, and difficulty regulating emotions.

“In these cases, people should seek help from a mental health professional.”

Separately, Abu Dhabi's Seha, the emirate's healthcare regulator, has introduced Esketamine, a nasal spray to treat severe depression in adults who have tried other treatments without success.

Esketamine targets new receptors in the brain than those which were traditionally addressed by antidepressant medications, Seha said.