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There is no cure for depression and almost every drug currently available has numerous side effects. Moreover, the majority of anti-depressants stop working after some time. Electroconvulsive therapy (ECT) has been used with some success but false myths about this treatment have led many patients to shy away from it. Along the same lines as ECT, there has been a renewed interest in developing non-drug therapies to treat depression. The latest surgical technique of deep brain stimulation (DBS) involves placement of electrodes into specific areas of the brain that affect mood. During deep brain stimulation, electrical impulses are delivered through the electrodes within the brain, which then relieve depression. The amount of stimulation is controlled by a pacemaker that is placed just underneath the collarbone.
DBS has been used to treat essential tremors and symptoms of Parkinson's disease. Some of these individuals with Parkinson's disease have reported an improvement in mood and thus, there has been an impetus to develop this technique for depression. Deep brain stimulation has been approved by the U.S. Food and Drug Administration as a treatment for relentless and debilitating obsessive-compulsive disorder (OCD) and is presently being investigated in patients with Tourette syndrome, chronic pain and other mental disorders.
Even though there has been a lot of hype about DBS, the procedure has not yet been approved by the FDA for treatment of depression. The technique remains experimental and is only available for those who want to participate in clinical trials.
To date only a few patients with depression have been studied and the results are somewhat promising. Data from the few patients who underwent DBS indicated that not all patients derived the same benefit and no one was cured of depression. Researchers are still trying to identify the best location for placement of electrodes to help reduce symptoms and have fewer side effects.
While all this sounds great, one should understand that DBS is a surgical procedure and does carry great risks. Some of the complications of surgery are more unpleasant than the depression itself. These include a stroke, bleeding, seizures, sudden jolts, infection, speech impairment, breathing difficulties, abnormal body movements and hearing problems. In addition, the pacemaker or the electrode may get infected and this means removal of all the hardware- which means another surgery.
The batteries used for the pacemaker only last a few months and need constant replacement. The battery replacement requires a surgical procedure and anesthesia. Like any mechanical device, the electrodes may break, kink, disconnect or may discharge inappropriately.
The surgery involves drilling two small holes in the skull and electrodes are guided into the brain using some type of imaging technique. The electrodes are then tunneled underneath the skin and connected to the pacemaker, which is embedded in the upper chest. After surgery, the pacemaker is evaluated and the amount of electrical stimulus you need is adjusted according to your moods and side effects. The pacemaker is automatically programmed using a magnetic device and stimulation is continuous.
Just because you undergo DBS does not mean you will be off your anti-depressant medications. The long-term results are unknown and while the dose of your anti depressant medication may be lowered, you definitely will not be stopping the medications anytime soon.
Therefore, before you jump into the queue for DBS, discuss the issue with your doctor and ask to speak to people who have had this procedure. Doctors always like to glorify any new procedure but what they do not always tell you is all the bad things that can happen. While anti-depressants do have many side effects, they are a much safer alternative than any type of brain surgery. So far, DBS is only reserved for individuals whose depression is severe and not controlled by any medication.
http://www.medscape.com/viewarticle/520659
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In Deep Brain Stimulation, the electrical impulses are controlled from the outside and patterned to each individual patient. The device regulates brain activity (altering the firing of the brain's neurotransmitters) 24 hours a day.
March 14, 2011 - 11:29pmDeep brain stimulation for depression
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