Deep brain stimulation provides long-lasting relief from severe depression

• The world's largest study of deep brain stimulation in the brain's reward system
• The study of 16 participants with depression previously resistant to treatment shows excellent results over one year
• Results published in the journal neuropsychopharmacology

Patients with severe, treatment-resistant depression may benefit not only from long-term deep brain stimulation, but also from long-term deep brain stimulation, as shown by researchers at the University of Friborg Medical Center. and their colleagues from the Bonn University Hospital. The team used thin electrodes to stimulate a deep part of the reward system in the brain of 16 patients. This led to a significant reduction in badessments of the severity of depression in all patients; it was halved on average. For half of the study participants, it was even reduced below the threshold considered the threshold of a depression requiring treatment. Most patients experienced these positive stimulatory effects during the first week and they lasted throughout the one – year study. The study was published online in the journal Nature. neuropsychopharmacology on Thursday, March 14, 2019.

"The most convincing result of the study is the sustained efficacy in very seriously ill patients.Most psychiatric treatments cease to be effective after months and years, we have demonstrated to the first time by demonstrating in a relatively large study that deep brain stimulation is a real option for patients with severe, treatment-resistant depression, "says Prof. Thomas Schläpfer, Group Leader, Head of Division of Interventional Biological Psychiatry from the medical center of the University of Friborg.

Success after dozens of unsuccessful treatments

It is estimated that 10 to 30% of all people with recurrent depression do not respond to approved treatments. Deep brain stimulation may be a therapeutic option for some of these patients. The 16 participants in the FORSEE-II study had severe depression for 8 to 22 years and had previously undergone an average of 18 drug treatments, 20 electroconvulsive treatments and 70 hours of psychotherapy – without success.

Dr. Volker A. Coenen, first author of the study and director of the Stereotactic and Functional Neurosurgery Unit of the Department of Neurosurgery of the University of Friborg Medical Center, and his team have implanted the Deep brain stimulation systems in the forebrain of the brain brain and used them to stimulate the medial bundle of the forebrain. This area of ​​the brain is involved in the perception and regulation of pleasure and reward and is therefore also important for motivation and quality of perceived life.

Cleared often in a few days

Physicians badessed the success of the therapy each month using Montgomery-Asberg's Depression Rating Scale (MADRS). The MADRS scores of ten study participants have already decreased significantly during the first week and have remained at a low level. All participants in the study responded to stimulation during the study. Eight of the 16 patients had a MADRS score of less than 10 points at the end of the study and were therefore considered non-depressive. "Our patients had been suffering from severe depression for years and showed no signs of improvement.The deep brain stimulation brought to most of them significant relief in a few days, which lasted throughout Absolutely sensational about the data in the study is that the effect seems to last a long time, the positive effects extending for years, "said Professor Schläpfer.

"A pilot study has taught us that stimulation of this brain region is very promising and we are looking forward to the replication of these important effects," said Professor Coenen.

Hope of a European approval of the method

On the basis of the results of the study that has just been published, researchers in Freiburg have already started the work of their third study (FORESEE-III) in October 2018. It will involve the treatment of 50 patients seriously. with depression. Fifteen patients have already had surgery. "If the follow-up study is as successful as the current study, we hope very much for European approval of the method," said Professor Schläpfer.

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