In a world where diseases and disorders are identified with greater precision and specialized pharmaceuticals are designed to treat illnesses with pinpoint efficacy, we tend to forget that medicine remains a “practice.” At least in the western world, we have begun to conclude that every condition has a diagnosis and every diagnosis has a successful treatment. How frustrating then for the person who knows that something is wrong but fails to find a suitable treatment.
A Beacon of Hope
A pilot study conducted in Canada may prove to be pivotal in finding successful treatment for those who suffer with major depressive disorder. A portion of those with the disorder suffer from severe depression but appear resistant to all available prescribed treatments. The study, which has only recently appeared in the online Journal of Neurosurgery, shines like a beacon of hope for hard to treat patients with severe depression.
The study was conducted over three disparate research facilities in Canada and followed 12 patients struggling with treatment-resistant depression. The patients needed to meet research criteria designed to establish resistance to standard treatment. Each of the patients in the study had suffered with depression an average of 20 years and had tried numerous pharmaceutical remedies. Many of the patients had tried numerous depression medications during their lifetime. Some of the patients had undergone electroconvulsive therapy (ECT) and some had attempted psychotherapy but all were unsuccessful in finding a suitable treatment for their depression. All of the patients a part of the study were considered to be disabled.
Researchers used the Hamilton Rating Scale for Depression to establish a baseline measurement for each patient. In addition, each patient’s depression was graded for its severity using the Clinical Global Impression of Severity (CGI-S). Once a clear baseline was established, patients were implanted with the Libra Deep Brain Stimulation system. This device is implanted in the patient close to his/her collarbone. From the device, tiny leads were set in the subcollosal cingulated region of the brain. This area, also known as the Brodmann Area 25 region, received electrical stimulation through minute impulses where it is believed they affect neurochemical transmitters and brain cells.
Significant Improvements After One Year
At the one year point, patients were again measured in comparison to their baseline depression scores. Researchers found that after a year of deep brain stimulation, formerly treatment-resistant patient’s experienced significant improvements. The study reported that 62 percent of patients receiving DBS experienced a 40 percent lessening of depression symptoms and 29 percent of patients enjoyed a 50 percent reduction in symptoms. Prior to receiving DBS, the study patients were labeled extremely or severely ill according to CGI-S scores, but following a year of DBS not a single patient fell into those categories.
More encouraging still 80 percent of patients at the one year mark manifested improvements and eight of the 12 who were able to resume normal life activities, were maintaining significant interpersonal relationships; two of these patients were diagnosed as in remission. The DBS device has already been successful in treating Parkinson’s disease, but has yet to be FDA approved for treatment of major depression. The study gives hope that its positive results will lay the groundwork for further research and eventually lead to an effective therapy for patients suffering with difficult to treat depression.