Nature Medicine mental illness treatment milestone: on-demand brain stimulation for severe depression

This research, published in the journal Nature Medicine on October 4, 2021, represents a milestone success in the efforts to apply advances in neuroscience to the treatment of mental illnesses over the years

"This research points the way to a new paradigm that psychiatry desperately needs," said Dr.

Previous clinical trials have shown that traditional deep brain stimulation (DBS) has limited success in treating depression, partly because most devices can only provide continuous electrical stimulation, usually only in one area of ​​the brain

The reason for the success of this proof-of-principle trial was the discovery of a neurobiomarker—a specific pattern of brain activity that indicates the onset of symptoms—and the team’s ability to customize a new DBS device that only recognizes Only react in this mode

Krystal said that compared with the 4 to 8 week delay of the standard treatment model, this customized method almost immediately relieved the patient's depressive symptoms, and it has lasted for 15 months, she has implanted the device

The patient’s name was Sarah, and she said, “I’m very depressed at the end of the team

Applying proven neuroscience advances to mental health

The University of California, San Francisco project started as a large-scale multi-center project initiated by President Obama's "Brain (Brain Research through the Advancement of Innovative Neurotechnology) Program" in 2014

Through this initiative, Edward Chang, MD, a neurosurgeon at the University of California, San Francisco, and his colleagues conducted research to understand the depression and anxiety of patients undergoing epilepsy surgery, and mood disorders in these patients are also common

Using the results of previous studies as a guide, the researchers developed a strategy that relies on two steps that have never been used in psychiatric research: mapping the patient's depression circuit and characterizing her neurobiomarkers

"This new study integrates almost all the key findings of our previous research into a complete treatment aimed at alleviating depression," said Chang, who is the co-senior author of the paper

In June 2020, the team evaluated this new method based on the FDA's investigational device exemption, when Chang implanted a responsive neurostimulation device that was successfully used to treat epilepsy

"We were able to provide this customized treatment for patients with depression, and it reduced her symptoms," Scangos said

In order to make the treatment more personalized, Chang placed one of the electrode leads in the brain area where the team found the biomarker, and the other lead in the area of ​​Sarah's depression circuit.

"The effectiveness of this therapy shows that we not only identified the correct brain circuits and biomarkers, but we were able to replicate it with implanted devices in a completely different later stage of the trial," Scangos said

Turn neural circuits into new insights

For Sarah, after years of failed treatment, the past year provided her with a real opportunity to make progress

She said: "In the first few months, the relief of the economic depression was very sudden.

The combination of these two things gave her her own perspective on the emotional triggers and irrational thoughts that plagued her in the past
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"Now," she said, "the thoughts will still emerge, but it's just.
.
.
puff.
.
.
the cycle stops
.
"

Although this approach looks promising, the research team warns that this is only the first patient in the first trial
.

"There is still a lot of work to be done," said Scangos, who has recruited two other patients to participate in the trial and hopes to add another nine patients
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"We need to study how these circuits change between different patients and repeat this work many times
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We need to know whether individual biomarkers or brain circuits will change over time as treatment continues
.
"

It will take a long time for the FDA to approve this therapy, but this study points out a new way to treat major depression
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Christo said that understanding the brain circuits behind depression may guide future non-invasive treatments that can regulate these circuits
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Skangers added: “When symptoms appear, we can treat them immediately.
This is a new way to solve the most difficult-to-treat depression cases
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”