A woman with severe depression has been successfully treated with an experimental brain implant in a “staggering” breakthrough that offers hope to people with intractable mental illness.
The device works by detecting patterns of brain activity related to depression and automatically interrupting them using tiny pulses of electrical stimulation delivered deep within the brain.
36-year-old patient Sarah said therapy gave her “a life worth living”, allowing her to laugh spontaneously for the first time in five years.
Although the therapy has only been tested on one patient – and is only suitable for people with severe illness – success is considered extremely important. This is the first demonstration that the brain activity underlying the symptoms of mental illness can be reliably detected and reveals that these brain circuits can be brought back to a healthy state, even in a patient who is not feeling well. For years.
“We haven’t been able to do this kind of personalized therapy before in psychiatry,” said Katherine Scangos, assistant professor of clinical psychiatry at the University of California at San Francisco (UCSF), who led the work. “This success in itself is an incredible advance in our understanding of the brain function that underlies mental illness.”
Professor Rupert McShane, consultant psychiatrist and associate professor at the University of Oxford, who was not involved in the trial, said: destructive. “
Between 10% and 30% of people with depression do not respond to at least two drug treatments, which equates to around 2.7 million people in the UK.
Over the past two decades, deep brain stimulation (DBS) has been used to treat tens of thousands of patients with Parkinson’s disease and epilepsy. However, several trials for depression have ended in disappointment. A major challenge is that the brain does not seem to have a single “zone of depression”; several interconnected domains may be at play and these may differ from person to person.
“We are starting to recognize some of the complexity involved in how mood is regulated in the brain as a network,” said Professor Edward Chang of the University of California at San Francisco, the neurosurgeon who treated Sarah.
A meticulous and personalized approach paved the way for the latest breakthrough. In an initial phase of a week, a temporary brain implant recorded a wide range of activities while Sarah regularly noted her mood on a tablet. A machine learning algorithm was used to identify a telltale pattern of activity in the amygdala region accompanying Sarah’s lowest points.
Through trial and error, the scientists identified a closely related area of the brain, the ventral striatum, where a tiny dose of electricity seemed to have an immediate and profound impact.
“When I received the first stimulation I felt the most intensely joyful sensation and my depression was a distant nightmare for a while,” Sarah said. “I just burst out laughing. This is the first time that I have spontaneously laughed or smiled… in five years.
In a second cycle of minimally invasive surgery, a permanent device was implanted, with a tiny battery built into her skull, to detect “depression signature” activity in the amygdala and automatically deliver stimulation to the striatum. ventral.
This happens about 300 times a day, which equates to about 30 minutes of stimulation. The electrical impulse is not accompanied by any sensation, Sarah said, other than a subtle sense of alertness and positivity.
“The idea that we can treat symptoms in the moment, as they arise, is a whole new way to deal with the most difficult to treat cases of depression,” said Scangos. She hopes the work will also help dissolve the stigma that “comes from the black box nature” of depression.
Sarah described a life before treatment in which she barely moved, had no opinions and “only noticed what was ugly in the world”. After five years of suffering, she had no more treatment options. The profound effect of the implant confirmed to him that his depression was rooted in the biology of the brain and “not a moral flaw, but a condition that could be treated.”
The device costs around $ 35,000 (£ 26,000) and is an adapted version of a device normally used to treat epilepsy, called the NeuroPace RNS System. The UCSF team has already recruited two more patients and hopes to recruit nine more to assess whether the technique can be more widely applied.
Professor Eileen Joyce, professor of neuropsychiatry at University College London, who is leading a trial using deep brain stimulation for OCD, said: “The results are genuine and significant. It is a remarkable piece of translational clinical neuroscience. I’m not sure anyone else in the world is doing it right now, but I’m sure they will in the future.
McShane said that although the method would not be widely or immediately applied, “if I was a medical student thinking about the area that would show exciting developments in my professional life, I would consider this a reason to consider psychiatry “. The results are published in the journal Natural medicine.