Brain pacemaker could treat severe cases of depression

Kathleen Blanchard's picture
Depression treatment
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Researchers suggest that using an implantable brain pacemaker could permanently lift severe depression.

The pacemaker treatment is actually a type of deep brain stimulation that the researchers say could be structured to treat patients with the most severe forms of depression.

The treatment involves placing a pacemaker type device under the collarbone with electrodes that attach to the brain. The device was originally developed to treat Parkinson's disease by stimulating specific areas of the brain. For depression treatment, long lasting results could be obtained, shown in three separate studies.

Depression does not return in patients who responded to the stimulation," explains Professor Dr. Thomas Schläpfer from the Bonn Hospital for Psychiatry and Psychotherapy. "The method appears to have lasting effects - and this is in the case of the most treatment-resistant patient group described in the literature. This has never before happened."

In the studies researchers used deep brain stimulation in three different areas - the nucleus accumbens, the internal capsule, and a structure in the brain known as cg25. The scientists discovered the same response occurred, regardless of where the stimulation was delivered. They explain the reason is that the three areas of the brain are linked and responsible for positive emotions.

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Bonn brain surgeon, Professor Dr. Volker Coenen explains in depressed patients the brain areas are not connected. "This circuit motivates us to take action," says Coenen. "In patients with depression, it is apparently disrupted. This results in, among other things, an extreme lack of drive - a characteristic symptom of the disease."

Dr. Coenen originally identified the brain structures that are located in the forebrain that all appear to be connected to the medial forebrain bundle. When one area is stimulated, the others are influenced. He proposes implanting the brain pacemaker electrodes for deep brain stimulation to treat depression permanently.

We would use the electrode to send the current pulses to the base of the network and not to the periphery, as before," explains Schläpfer. "We could thus potentially work with lower currents and yet achieve greater success."

Coenen says scientific evidence supports the notion that deep brain stimulation should work to bring relief from depression that is severe and difficult to treat. The brain pacemaker is already being used in 80,000 patients with Parkinson's disease worldwide. He says from a medical viewpoint deep brain stimulation should be able to help patients with severe depression.

Neuroscience and Biobehavioral Reviews (doi: 10.1016/j.neurobiorev.2010.12.009).

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