Woman Recovers From 46 Years of Depression After Deep Brain Stimulation

A sixty-four year old woman who has suffered depression since she was eighteen is now symptom-free after undergoing a new form of deep-brain-stimulation carried out by a team of neurosurgeonsa at Heidelberg University Hospital and psychiatrists at the Central Institute of Mental Health, Mannheim. She had previously been unresponsive to medication and electroconvulsive therapy.

In deep brain stimulation, electrodes are inserted into the brain and are connected with wires under the skin to an electronic impulse generator implanted in the chest. The electrodes emit current that continuously stimulates specific areas of the brain. This therapy, also described as “brain pacemaker”, is already used successfully for patients suffering from Parkinson’s disease or other movement disorders.

Depressive patients have already been treated with electrostimulation with some success. However, two other areas of the brain were stimulated, located in the forebrain or midbrain regions.

The new method targets an area of the brain called the habenula. The habenula is located further downstream next to the brain stem.

“We decided to stimulate  the habenula because it is involved is the control of three major neurotransmitter systems, which are known to be disturbed in depression,’” explained psychiatrist Dr. Alexander Sartorius  from the Central Institute of Mental Health.

Scientific studies have shown that the habenula is hyperactive in depression, the idea was to make this structure less active by electrically stimulating it. The surgical procedure is based on a hypothesis of how the habenula is involved in depression that was first formulated by Dr. Alexander Sartorius, psychiatrist at the Central Institute for Mental Health (CIMH; Director: Professor Andreas Meyer-Lindenberg; former Director CIMH Professor Fritz Henn, Brookhaven National Laboratory, New York).

Depression is a common psychiatric illness; some one third of patients do not respond to medication or psychotherapy. Electroconvulsive therapy, used for such severe or treatment resistant cases, is also not always effective. This was also the case for the patient in this case.

The success of the procedure was confirmed when the electrode was accidentally switched off: the patient had a bicycle accident which required surgery for which an ECG had to be made as preparation. The brain pacemaker was switched off and was not reactivated for a few days, and the depression promptly returned. A few weeks after reactivation, the patient completely recovered  again.

The neurosurgeons in Heidelberg and the psychiatrists in Mannheim now want to build on this positive experience and are planning a clinical study in which the habenula stimulation is to be implemented for severely depressive patients at five psychiatric-neurosurgery centers in Germany. “We aim to show that habenula stimulation has a better success rate than other target areas attempted for depression and that it is also safe to use,” says Dr. Sartorius, Coordinating Investigator of the proposed study.

Reference:

Remission of major depression under deep brain stimulation of the lateral habenula in a therapy-refractory patient. Sartorius A, Kiening KL, Kirsch P, von Gall CC, Haberkorn U, Unterberg AW, Henn FA, Meyer-Lindenberg A. Biol Psychiatry. 2010 Jan 15;67(2):e9-e11.

Source: Adapted from a press release supplied by EurekAlert

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