She was willing to try something extreme: having electrodes implanted in her brain as part of an experimental therapy.
Researchers say the treatment — called deep brain stimulation (DBS) — could ultimately help many of the nearly three million Americans who, like her, suffer from depression that resists other treatments. DBS is approved for diseases such as Parkinson’s disease and epilepsy, and many doctors and patients hope it will soon be widely used for depression.
Directed electrical impulses, just like a pacemaker
The treatment gives patients targeted electrical impulses, like a brain pacemaker. Recent research is increasingly promising and more is underway, although two large studies that showed no benefit of DBS in treating depression temporarily halted research progress, and some scientists continue to express concern about this new approach.
Meanwhile, the U.S. Food and Drug Administration (FDA) has agreed to expedite review of Abbott Laboratories’ application to use its DBS devices for depression that does not resolve with other treatments.
“At first I was impressed because the concept seems very intense. It’s brain surgery. You have wires built into your brain,” explains Hollenbeck, who is involved in ongoing research at Mount Sinai West Medical Center. “But I also felt like I had tried everything up to that point, and I was desperate for an answer.”
Fight depression
Hollenbeck suffered from symptoms of depression as a child while growing up poor and occasionally homeless. But her first major attack occurred at university, after her father’s suicide in 2009. Another one occurred during a stay with the Teach for America organization, which left her almost immobilized and worried about losing her teaching job and going into deep depression. new to poverty. She went to the hospital.
“I ended up having a kind of on-and-off pattern,” he explains. After improving a little with medication for a while, he would relapse again.
He managed to obtain a doctorate in psychology, even after losing his mother in the last year of his degree. But the black hole always came back to drag her inside it. Sometimes, she says, she thought about taking her own life.
He said he had exhausted all options, including electroconvulsive therapy, when a doctor told him about DBS three years ago.
“Nothing else worked,” he notes.
She became one of only a few hundred people treated with DBS for depression.
Hollenbeck underwent brain surgery under a sedative, but is awake. Dr. Brian Kopell, who directs the Mount Sinai Neuromodulation Center, placed thin metal electrodes in a region of the brain called the subcallosal cingulate cortex, which regulates emotional behavior and is involved in feelings of sadness.
The electrodes are connected by an internal cable to a device placed under the skin of your chest, which controls the amount of electrical stimulation and delivers constant, low-voltage pulses. Hollenbeck calls it “continuous Prozac.”
Doctors say stimulation helps because electricity speaks the brain’s language. Neurons communicate using electrical and chemical signals.
In normal brains, Kopell explains, electrical activity reverberates unhindered in all areas, in a kind of dance. In depression, that dance gets stuck in the emotional circuits of the brain. DBS seems to “unclog the circuit,” she said, allowing the brain to do what it normally would do.
Hollenbeck said the effect was almost immediate.
“The first day after the operation she began to feel that that negative mood, that heaviness, was gone,” explains her psychiatrist, Dr. Martijn Figee. “I remember her telling me that, for the first time in years, she could enjoy Vietnamese takeout and really taste it. “She began decorating her house, which had been completely empty since she had moved to New York.”
For Hollenbeck, the most profound change was finding pleasure in music again.
“When I was depressed, I couldn’t listen to music. It sounded and felt like I was listening to radio static,” she said. “Then one sunny summer day, I was walking down the street listening to a song. I just felt this encouragement, this: ‘Oh, I want to walk more, I want to go and do things!’ And I realized that I am improving.”
All he wishes is that therapy had existed for his parents.
The treatment
The path to this treatment dates back two decades, when neurologist Helen Mayberg led the first promising research.
But some setbacks followed. Large studies initiated more than a dozen years ago showed no significant differences in response rates between treated and untreated groups. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, who also researches DBS and depression, cited a couple of reasons: The treatment was not personalized, and researchers analyzed the results in a matter of weeks.
Some subsequent research showed that patients with depression obtained stable and long-lasting relief from DBS when observed for years. Overall, DBS for depression is linked to average response rates of 60% across different brain targets, a 2022 study indicated.
Currently, the treatments in which several teams carry out tests have a much more personalized design depending on the case. The Mount Sinai team is one of the leading teams in the United States in DBS research for depression. There, a neuroimaging expert uses brain imaging to locate the exact spot where Kopell should place the electrodes.
“We have a template, a blueprint of exactly where we’re going to go,” said Mayberg, a pioneer in DBS research and founding director of the Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai. “Every person’s brain is a little different from the next, just like people’s eyes are a little further apart or a nose is a little bigger or smaller.”
Other research teams also tailor treatment to patients, although their methods are slightly different. Scangos and her colleagues study various targets in the brain and administer stimulation only when it is necessary for severe symptoms. She said the best therapy might end up being a combination of approaches.
While teams continue to work, Abbott will launch a large clinical trial this year, ahead of a possible FDA decision.
“The field is moving pretty quickly,” Scangos said. “I am hopeful that we will get approval before too long.”
But some doctors are skeptical, highlighting the possibility of complications such as bleeding, stroke or infections after surgery.
Dr. Stanley Caroff, professor emeritus of psychiatry at the University of Pennsylvania, said scientists still don’t know the exact pathways or mechanisms in the brain that cause depression, which makes it difficult to choose where to stimulate. It is also difficult to select appropriate patients for DBS, and there are approved and effective treatments for depression.
“I think psychiatrically, the science is not there,” he said of DBS for depression.
Hollenbeck acknowledges that DBS has not been a total cure; She continues to take anti-depression medication and needs constant care.
He recently visited Mayberg in his office and talked to him about his recovery. “It’s not about being happy all the time,” the doctor told him. “It’s about making progress.”
That’s what researchers are now studying: how to track progress.
Recent research by Mayberg and others published in the journal Nature showed that it is possible to get a “reading” of how a person is doing at any given moment. By analyzing the brain activity of patients who received DBS, researchers found a unique pattern that reflects the recovery process. This gives them an objective way to observe how people improve, and distinguish between impending depression and typical mood fluctuations.
Scientists are confirming these findings using newer DBS devices in a group of patients including Hollenbeck.
She and other participants do their part mainly at home. She regularly provides brain recordings to researchers by connecting to a tablet, placing a remote control over the pacemaker-like device she wears on her chest, and sending the data. She answers questions that arise about how she feels. She then records a video that will be analyzed based on aspects such as facial expression and speech.
From time to time, Hollenbeck enters Mount Sinai’s “Q-Lab,” an immersive environment where scientists conduct quantitative research by collecting all kinds of data, including how you move in a virtual forest or make circles in the air. arms. Like many other patients, now that she is better she moves her arms faster.
Data from recordings and visits is combined with other information, such as events in your life, to record your progress. This helps doctors make decisions, such as increasing your dose of electricity, which they once did.
On a recent morning, Hollenbeck pushed aside her necklace and hair to reveal the DBS surgery scars on her chest and head. For her, they are marks of how far she has come.
He moves around the city, walks through the park and visits libraries, which were a refuge in his childhood. He no longer worries that life’s normal challenges will lead to crushing depression.
“Sometimes the stress is pretty extreme, but I’m able to see and remember, even on a bodily level, that I’m going to be okay,” she says.
“If I hadn’t had DBS, I’m pretty sure I wouldn’t be alive today,” she added.
Source: AP
