Deep Brain Stimulation for Depression

Deep brain stimulation (DBS) is a treatment that involves implanting a small device, similar to a pacemaker, into the brain. This device sends electrical impulses to specific brain areas to adjust neural activity, helping restore healthy brain function.

For severe depression, DBS specifically targets the subcallosal cingulate cortex and other areas involved in mood regulation, aiming to correct abnormal brain activity and improve symptoms.

DBS is a promising option for people with severe, treatment-resistant depression. It’s typically used after other treatments haven’t been successful.

• male gender
• severe depression
• hospitalization due to depression
• those between the ages of 16 and 29 years or 30 and 49 years

The effectiveness of DBS for treatment-resistant depression can vary from person to person. However, recent studies suggest it’s a relatively safe procedure that may have minimal side effects postsurgery.

A review of studies from 2021 that focused on targeting seven brain areas with DBS found that 56% of participants showed improvements in their depression symptoms. Of these, 35% went into remission, while 14% experienced a relapse.

Side effects were reported by 67% of participants, most of which were moderate, though there were serious concerns like suicidal thoughts or attempts.

DBS involves implanting a small device in the brain that sends electrical impulses to specific areas. These impulses help regulate brain activity and can relieve symptoms of depression.

Here’s how it works:

• Implantation: A surgeon places a small electrode in a targeted area of the brain associated with mood regulation. This area is often the subcallosal cingulate gyrus or the nucleus accumbens, though other targets are also used.
• Device function: The electrode is connected to a device implanted under the skin, usually near the collarbone. This device generates electrical impulses that travel through the electrode to the brain.
• Regulation: The electrical impulses help adjust the brain’s activity patterns, which can reduce symptoms of depression. By altering these patterns, DBS can help improve mood, increase energy, and restore interest in activities.
• Ongoing treatment: The device requires regular adjustments to ensure it continues to work effectively. This involves fine-tuning the electrical impulses based on the patient’s response.

After receiving DBS to treat depression, here’s what to expect:

• Initial recovery: You will likely have some discomfort and swelling postsurgery. A hospital stay of about 1 or 2 days will be required, followed by a gradual return to usual activities. Full recovery can take a few weeks.
• Follow-up: Regular follow-up visits are necessary to adjust the pulse generator and monitor your response. These appointments help fine-tune the therapy for the best results.
• Side effects: Potential side effects include surgical risks like infection or bleeding. You may also experience stimulation-related issues such as headaches or dizziness and rare cognitive or emotional changes.
• Effectiveness: Improvement in symptoms may take weeks or months, and results can vary. Some individuals may need adjustments to their stimulation settings or additional treatments.
• Ongoing monitoring: Continuous monitoring is essential to assess effectiveness and manage side effects, ensuring the DBS system remains effective.

For treatment-resistant depression, several alternative options may be possible:

A fast-acting antidepressant administered intravenously or as a nasal spray, ketamine can provide rapid relief for some individuals with TRD.

One study suggests that ketamine significantly improves depression and anxiety symptoms within 1 hour of the first dose. The participants also showed sustained benefits after 2 weeks and 1 month of treatment.

This well-established treatment involves applying electrical currents to the brain to induce controlled seizures, which can help alleviate severe depression symptoms.

A noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain, potentially improving mood and reducing depressive symptoms.

Involves implanting a device that sends electrical impulses to the vagus nerve, which can influence brain activity and mood.

Advanced forms of therapy, like cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT), can be effective for some individuals, particularly when combined with other treatments.

Speak with your doctor before stopping or making changes to your treatment plan. They will be able to suggest different types of medication or prescribe a different dosage of your current medication.

Incorporating exercise, a healthy diet, and mindfulness practices can complement other treatments and improve overall well-being.

A 2022 review of studies suggests eating a healthy diet, especially one rich in vegetables and fruits, may reduce the risk of depressive symptoms. Conversely, avoiding pro-inflammatory diets high in junk food and red meat could also help lower this risk.