Originally used to help manage Parkinson’s disease, deep brain stimulation (DBS) might be a viable option for some depression patients. For DBS, tiny electrodes are implanted in the part of the brain that regulates mood. Although long-term success rates have yet to be established—DBS has only been practiced since the 1980s and it is still a rare procedure—some doctors recommend deep brain stimulation as an alternative therapy for patients whose previous depression treatments have been unsuccessful.
How Deep Brain Stimulation Works
A doctor surgically implants tiny electrodes in the nucleus accumbens, which is the region of the brain responsible for dopamine and serotonin release, motivation, and mood. The electrodes are connected via wires to a pacemaker-like device implanted in the chest that delivers pulses of electricity to the brain. The pulses, which are generally delivered constantly 24 hours a day, appear to block the firing of neurons and return the brain’s “metabolism” back to a state of equilibrium. The pacemaker can be programmed and controlled from outside the body by using a handheld device. Although doctors aren’t exactly sure why the pulses help the brain reset, the treatment appears to improve mood and give the patient an overall sense of calm.
In many DBS clinical trials, patients have reported alleviation of their depression and a significant increase in quality of life. In addition to depression, deep brain stimulation is also used to treat patients with obsessive-compulsive disorder, anxiety, epilepsy, and high blood pressure.
Who It’s For
Deep brain stimulation is an option for people with chronic or treatment-resistant depression. Doctors always recommend extended courses of psychotherapy and/or drug therapy before considering DBS because it involves an invasive surgical procedure and is a fairly new form of treatment. Patient age is usually not an issue, but doctors recommend that individuals be in good enough health to withstand a major surgery.
Deep brain stimulation is generally recognized to be a safe procedure. However, as with any type of brain surgery, complications can always arise. Common problems associated with DBS include brain hemorrhage, infection, headache, speech problems, and sensory or motor control issues.
Another factor to consider is the need for subsequent surgeries. The chest-implanted monitoring device can break, and its batteries last between six and 18 months only. Also, the implanted electrodes may need to be adjusted if the treatment does not appear to be working. Thus, patients should consider whether they are healthy enough to undergo a second or third surgery.
What the Experts Say
Because deep brain stimulation is still a fairly new procedure and long-term studies and clinical trials show varying results, doctors can only point to their own successes or failures with DBS. Dr. Joseph J. Fins, chief of medical ethics at New York-Presbyterian/Weill Cornell hospital, says that using DBS for mental-emotional conditions should be “adequately tested before it’s called a therapy.”
However, other experts think deep brain stimulation is a viable option for patients who aren’t seeing success with other therapies. Dr. Ali R. Rezai of the Cleveland Clinic notes that deep brain stimulation “holds promise for the treatment of intractable major depression.” The one thing most doctors agree on is that DBS should be a second or third choice for treating depression and that patients should explore drug therapies before opting for the procedure.