Depression affects about 16 million Americans every year and is the leading cause of disability worldwide. While many people with depression can be treated effectively with medication and psychotherapy, as many as 30 percent of people don’t respond well to conventional treatment. A new study shows promise for treating severe depression with deep brain electrical stimulation. The study was conducted by a team led by Edward Chang of the University of San Francisco. The team took advantage of a procedure commonly used to prepare epileptic patients for surgery. Epileptic seizures typically originate in one area of the brain and spread to other areas until the patient has a seizure. The surgery involves locating and removing the part of the brain where the seizures originate. To do this, surgeons implant electrodes in the patient’s brain to monitor activity in various regions so they know what to remove. It also happens that many people with epilepsy also suffer from depression. In this study, Chang and his team examined 25 depressed patients who had been implanted with electrodes in preparation for surgery. The patients’ depressive symptoms had been previously assessed with the Beck Depression Inventory. The team then stimulated various regions of the brain via the implanted electrodes and asked the patients to assess their mood. Stimulating most brain regions had no effect on mood at all. However, when the team stimulated an area called the orbitofrontal cortex, many patients experienced a significant improvement in mood in a matter of minutes. The orbitofrontal cortex is not well understood, but we know that it is well connected to other regions of the brain responsible for mood and decision making. It is well positioned to coordinate mood and cognition. We know that various parts of the prefrontal cortex help to regulate emotions and that these areas are often underactive in people with depression. This appears to be the case with the orbitofrontal cortex, but only patients with moderate to severe depression felt the beneficial effects of stimulation. Promising as this study is, it does have some limitations. First, it’s a relatively small study with only 25 participants. Also, all of those participants also have epilepsy. We don’t know yet whether depression is significantly different in people with epilepsy or whether deep brain stimulation would also be effective in the wider population of people with depression. Finally, the effect was only measured over a very short period, just minutes. The researchers don’t know whether repeated treatments would have a more lasting effect. However, transcranial magnetic stimulation, a non-invasive procedure that works on the same principal, appears to improve patients’ moods for a year or more by repeating treatments daily for a month or six weeks. This study may provide data leading to other effective treatments for treatment-resistant depression.
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