Combining deep-brain stimulation with intracranial EEG helped researchers achieve an individualized understanding of specific brain networks that contributed to an individual’s depression symptoms and identified stimulation patterns best suited to each patient for symptom relief.

A patient who suffers from treatment-resistant depression (TRD), is the first person to participate in a clinical trial using deep brain stimulation (DBS) to treat TRD led by doctors and scientific researchers at Baylor College of Medicine with help from UT Southwestern Medical Center.

Brain Stimulation for Depression Procedure

Patients are awake during surgery as electrical leads are implanted in their brains. This procedure uses a first-of-its-kind approach that incorporates intracranial EEG recordings and stimulation to personalize the understanding of network behavior in the brain during a depressive state and its response to the DBS device. The findings were published in Biological Psychiatry.

“I was in the middle of a depressive episode that had lasted five years. I tried a number of different therapies and medication, ones that worked for me in the past and some new ones, but nothing was making a difference this time,” the patient said. “Depression was nothing new to my life. I had attempted suicide in a past depressive state and ended up in a coma for a short time, so I knew this was something I had to take control of.”

The patient began searching online for options and came across several articles that eventually led him to Baylor. “The goal of our study is to find a way to personalize the treatment. No two people have the same experience with depression. It can produce different behaviors, thoughts, and feelings from person to person. We reasoned that these differences in experience reflect variations in brain activity patterns,” said a lead doctor on the study.

“We were able to show that by using DBS and intracranial EEG readings we could achieve an individualized understanding of the specific brain networks contributing to a patient’s particular depressive symptoms and identify stimulation patterns that were best suited for that patient.”

Initial Results of Brain Stimulation Surgery for Depression

While the patient described feeling like he could think clearer on the operating table as electrodes were being implanted and tested, the process to finetune the device takes months. He stayed in the hospital for 10 days for a series of tests, and over the following weeks and months, researchers continued to program and adjust the device. The patient noted it took about four months until he was considered to be in remission from depression.

“The stimulation settings selected during this research study are different from those I would have chosen based solely on my clinical experience doing programming,” said Goodman. “The excellent outcome for this person is encouraging news that DBS can be tailored to the individual based on their unique brain activity patterns.”

Procedures such as these can sometimes be influenced by a placebo effect—that is, improvement in symptoms unrelated to the DBS therapy. “The patient wants to feel better, so they may start to actually feel better regardless of stimulation. To confirm that the improvement was caused by DBS, we slowly reduced the amount of stimulation in a double-blind phase of the study. His symptoms worsened during this phase, proving that DBS was actually causing the improvement. Turning the system back on to full power again produced remission of symptoms.”

DBS Therapy

DBS works by sending electrical signals to the areas of the brain where the electrodes have been implanted. It is most commonly used for movement disorders such as Parkinson’s disease, where the signals help restore balance to the movement-regulating regions of the brain in order to reduce the motor symptoms of Parkinson’s.

“These DBS targets are thought to be hubs at the crossroads of critical white matter pathways that connect cortical and subcortical network regions relevant to the expression of depressive symptoms. SCC stimulation more often reduces negative feelings and VC/VS stimulation usually increases positive feelings. This is the first study to target both regions at the same time. In doing, so we will have more specific control over depression symptoms and therefore be better able to tailor the DBS to each individual patient’s needs.”

In the first 10 days in the hospital, researchers were able to see what the patient’s brain activity pattern looked like across a range of mood states. These varying mood states resulted from natural variation, but they also were evoked, for example by watching video clips with happy or sad content. The next step was to deliver stimulation to identify settings that produced activity patterns that more closely resembled healthier states.

The patient experienced steady improvement in his symptoms over the following weeks.

The lead investigators emphasize that the reaction to the device can be different for each person. Others could take longer to have a positive reaction while some might only need minor adjustments to reach a healthy state. A total of 12 participants will be enrolled at both Baylor and UT Southwestern. Each participant will have a different set of stimulation patterns that work best for them. That is one of the reasons why the patient says it is hard for him to describe his depression to others—everyone’s experience can be unique.

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Original Post by Neuroscience News with data from Baylor School of Medicine

Quotes from Biological Psychology