Friday, October 22, 2021

Targeted electrical brain circuit stimulation a hope for depression

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Sarah hasn’t laughed in over five years.

Living in the San Francisco Bay Area, he has long stopped seeing the natural beauty of the region. He lost so much connection with his mind that he ordered his friends what would happen when he went out to dinner. He just knew he wanted to die.

But part of it was open enough, so he volunteered for a clinical trial at the University of California (San Francisco) to treat severe depression.

She underwent brain surgery a year and twice as Sarah, 36, told her story.

Asked to give her name, Sarah, the only person treated with electrodes embedded deep in her brain, sends out rapid energy bursts when they detect activity in a depressed brain chain.

These 6-second gaps — about 300 a day — changed his life and gave him new insights into the biological nature of depression.

His experiences are too complex to replicate for millions of frustrated people, but his success may offer new ways to treat one of the most difficult mental illnesses.

“It’s great,” said Dr. Darin Dugerty, a psychiatrist who uses a similar but less developed approach to treating obsessive-compulsive disorder at Massachusetts General Hospital and McLean Hospital. “It’s very exciting because it’s the next step … that’s what we need to do for depression.”

Andres Lozano, a professor of neurosurgery at the University of Toronto, said the research should be taken with pleasure, but with caution.

“It’s just one patient, so we have to be careful,” he said. “But if it translates to other patients and the results last longer, it’s very exciting.”

Help from despair

Deep brain stimulation has been used for years to treat Parkinson’s disease, epilepsy, and obsessive-compulsive disorder, but the UCSF approach has continued by personalizing treatment, targeting specific brain chains rather than regions, and providing intermittent flow rather than continuous flow. . electricity.

Catherine Skangos, who helped lead the study, which was published in the journal Nature Medicine on Monday, said it was so complex and unique. required to treat a complex and individual condition such as depression.

Two more patients have been enrolled in the test, and Skangos hopes to eventually include nine more. Additional patients will help the community review how brain cycles associated with depression differ and improve the personalization process.

A better understanding of brain chains can lead to different ways of modulating them – hopefully it won’t require brain surgery and will be easier to present to more people, Scangos said.

Sarah is being treated with electrical stimulation to treat depression.

Approximately 250 million people worldwide suffer from depression and 10% -20% of them do not receive help from current treatment. Among them was Sarah. He tried many medications and electroconvulsive therapy during a five-year period of extreme depression.

When the stimulator was first turned on, his mood almost rose.

“I felt the strongest joy,” he said. He remembers the researchers looking at him when he laughed out loud. “When I first laughed at this on my own, I hAcesparks’t smiled in five years.

When the device is turned off, dark thoughts return, but even if it is more than a year since it is fully operational, its depression will remain in the memory for a long time.

“Within a few weeks, the idea of ​​suicide disappeared,” he said. “Then it was a gradual process, as if my worldview had changed.”

His hobbies, which distracted him from the idea of ​​suicide, were pleasurable for the first time. Returning home from a workout, he noted the stunning color and light of the Gulf of San Francisco, where he met the swamps. “My friend who was driving the car looked at me like crazy – I surprised them so much that I said that,” he said. “When I was depressed, I just saw something bad.”

She now sees herself as having a good time, where enjoying workouts allows her to feel better, and she benefits from therapy that doesn’t help when she’s at her lowest.

Run the correct circuit

Neurosurgeon Edward Chang, who operated on Sarah and invented the experiment seven years ago, said he expects brain stimulation to be “independent” therapy, but used in conjunction with other methods, including rehabilitation and medication.

The stimulus is carefully tuned so Sara doesn’t notice the gaps, but she said she thought she knew in the 15-20 minute mirror because she was so alert, energetic and had a sense of positivity.

Hours of repeated visits to the UCSF, turning the stimulator on and off, and calibrating the charge were necessary to determine the exact pattern of Sarah’s depression.

Skangos said she was worried that over-stimulation could cause another type of mental illness, but Sarah had no such side effects. He said it has fewer side effects than many side effects.

Chang said he expects the process to be simplified as researchers better understand the effects of stimulating different periods of the brain and improve their ability to identify what is important in each.

In Sarah’s example, one of her two implanted devices detected a site of abnormal activity, a stimulator typically used to treat epilepsy that automatically sends an electrical stimulus once it detects the movement.

The stimulant only goes off when it is believed that depression lies at the bottom of the disorder. This means that the battery will last a long time – about 10 years, according to Scangos accounts.

A matchbox-sized battery is mounted on his skull so he doesn’t notice it. Two minimally invasive surgeries were less annoying than an extended MRI, which had to be performed to detect a malfunction of the nervous system.

Chang said he had to adjust the existing devices to work the way he wanted. According to him, the cost of basic equipment is about $ 30,000.

“We’re just beginning to figure out how it works,” Chang said. “There’s a lot we need to learn.”

Hope, Chang said, will eventually be able to identify and target key chains in a depressed person’s brain without the need for surgery.

For now, he said, the surgical procedure will be “more precise and targeted, with more control and fewer side effects”. In addition, since the stimulator can be monitored remotely, the patient does not have to return repeatedly to adjust.

Sarah will be working in her garden on Saturday, September 25, 2021.

Reducing the stigma of depression

One of the unknowns is how long the benefits will last.

Previous studies using deep brain stimulation to combat depression have shown no difference between people who turned the stimulus on and those who did not. A two-year study showed a significant improvement in half of the people who were stimulated, said Lozano, who participated in the study.

In such cases, the stimulator is turned on 24/7 and its location is not adjusted.

According to Lozano, better results come from doing both. “The brain works by getting the right information at the right place at the right time,” he said, and hoping for a more accurate target will give better and longer-term results.

He also thinks that the UCSF group’s chain-focused work, rather than the brain region, makes sense. For example, movement difficulties associated with Parkinson’s disease come from a specific area of ​​the brain, and each person has a deep brain stimulator. But the symptoms of depression vary, and in addition to mood, they affect things like sleep, memory, and attention.

Exposure to the scheme, he said, will help address all of these symptoms.

In Sarah’s example, her amygdala continued to the abdominal striatum, which is involved in decision-making, controlling fear and other strong emotions.

“We’re starting to recognize some of the complexities involved, including how to regulate mood in the brain as a network … interactive areas in the brain that evoke really complex emotions that underlie things like depression and anxiety “. .

Focusing on networks, he said, “gives us more opportunities and hopes to think about how to adapt these treatments to patients in the future.”

Meanwhile, Sarah, her doctors and other experts in the field say such experiences should help eradicate depression and other mental illnesses.

If treatment doesn’t work after treatment, Sarah said, “I felt like a personal moral failure.” But as her brain spun, her depression rose instantly, and Sarah realized that her black mood wasn’t her fault.

“No one will ever tell you that if you treat a person with Parkinson’s disease positively, you will cure yourself,” he said.

“The hardest part of living with depression is the stigma,” he added. – That’s why I kept anonymous.

Suicide Line: If you or someone else is struggling with suicidal thoughts, you can contact the U.S. National Suicide Prevention Line at any time of the day or night. 800-273-TALK You can call (8255) or chat on the Internet.

The crisis text line provides 24/7 free confidential help to people in crisis via SMS when calling 741741.

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety is partly achieved through a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial information.

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