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Sarah had no more options. For five years, she had tried every possible treatment for her severe depression, and nothing had helped. “My daily life had become so restricted and impoverished by depression that I felt tortured every day,” said the 36-year-old.
But after undergoing an experimental procedure that implanted a device in her brain, she felt her depression increase for the first time in years. “It was as if my focus on the world had changed,” said Sarah, who remains anonymous due to the stigma surrounding depression, during a press briefing.
Sarah was the patient of a proof-of-concept trial of a new approach to the treatment of severe and treatment-resistant depression, published today in the journal Natural medicine. The results open up another possible strategy to help people with the disease. The study only involved Sarah, and it’s still unclear if this might work well in other people. The lessons from the trial, however, helped researchers better understand the nature of depression and could be applied to other efforts to treat the disease.
“We have identified some fundamental properties of the brain through this test,” study author Katherine Scangos, a psychiatrist at the Weill Institute for Neuroscience at the University of California at San Francisco, told the conference. hurry. “We believe these brain findings will be available to the general public and will help us develop new personalized treatments for depression. ”
The trial used a technique called deep brain stimulation, where electrodes implanted in the brain deliver electrical impulses in an attempt to alter or regulate abnormal brain activity. It’s common for conditions like epilepsy and Parkinson’s disease. Research over the past decade has shown that it can sometimes help with depression, but the results have been inconsistent. Most of the previous efforts have provided stimulation to individual areas of the brain believed to be involved in depression. This study, however, was targeted at regions that are part of a specific brain. circuits – interconnected parts of the brain which are responsible for specific functions.
“What we are realizing more and more now is that depression is caused by faulty circuits,” says Scangos.
In addition, the circuits involved may be different for each person. Thus, in this trial, the study team personalized the therapeutic approach according to the specific patient’s depression. They mapped out the type of brain activity that occurred when Sarah’s depression symptoms flared. Then, they surgically implanted a device capable of detecting this brain activity and sending stimulation to the circuit where the activity took place.
For Sarah, the procedure was very effective. His scores on the depression rating scales dropped the morning after turning on the device. And perhaps more importantly, she felt dramatic changes in her mood. On her first stimulation, she burst out laughing in the lab. “And everyone in the room said ‘Oh my god’ because it’s the first time I’ve spontaneously laughed and smiled, where it wasn’t faked, in five years,” he said. she declared.
Sarah’s depression circuit trips hundreds of times a day, and each time the implanted device delivers a brief pulse of stimulation. In total, she receives about 30 minutes of stimulation each day, Scangos says. Sarah can’t feel the pulses, but said she has a general idea of when they occur throughout the day. “There is a sense of alertness and energy or positivity that I’m going to feel,” she said.
Despite Sarah’s resounding success, this essay was only a first demonstration of this approach. The device used in the trial is not licensed to treat depression – it was originally designed to treat epilepsy and was used in the trial under an investigational device exemption from the FDA. “We have a lot of work ahead of us as an area to validate this finding to see if this is really something that will endure as a treatment option,” said Edward Chang, author of the study. and chairman of the department of neurosurgery. at UCSF.
If it turns out that it works for other people, it will probably only be used after trying all other options, Chang says. Surgery – especially brain surgery – is always a risk. For patients with Parkinson’s disease and epilepsy, patients who take this route have usually tried all other treatments. “At the moment, a lot of these approaches are considered a last resort,” Chang said. It is also an expensive approach – the device used in this study typically costs between $ 35,000 and $ 40,000.
But even this simple demonstration could help advance our general understanding of depression. The team was able to identify circuits in the brain involved in depressive symptoms in at least one person, and these circuits may be shared by other patients. Having basic information about the circuits of depression could help develop nonsurgical strategies targeting similar areas. “Having this information and knowledge is, in our view, going far beyond this application,” Chang said.
Sarah believes her success might also help remove some of the stigma surrounding depression. The study helped Sarah reframe her relationship with the disease, she said. Throughout her life she said that she had internalized part of the idea that she should be able to feel better if she got up and tried hard enough. “We tried every treatment we could, and I had such a positive outlook through it all, and none of it worked. And that only made the depression worse and made me feel like I was the worst patient in the world, and it was my own moral failure, ”she said.
The trial was a game-changer and helped her doctors constantly refrain from calling her depression a disease of her brain. ‘”Sarah said.
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