DBS (or deep brain stimulation) has been shown to be a feasible option for some individuals who have moderate to severe depression. Earlier, DBS was solely used to manage the symptoms of Parkinson’s disease. However, the indications have been rapidly advancing and there is an increasing interest in the application of these surgeries in Psychiatric disorders also. In DBS, a surgeon implants tiny electrodes in that region of the brain that successfully regulates mood. Some surgeons have practiced this form of surgery since the 1980s; that said, it is a rare surgical intervention. Though long-term success rates still need to be established, some surgeons have recommended DBS as an alternative therapy for those individuals whose prior treatments for depression have not been successful.
How DBS Works In Combatting Depression
Through surgery, tiny electrodes are implanted in the nucleus accumbens, which is part of the brain responsible for the release of neurotransmitters such as serotonin and dopamine and the regulation of mood and motivation.
This surgical procedure involves multiple steps. First, the surgeon places the electrodes. After a few days, they implant the battery pack and wires. The electrodes are connected through wires to a device that resembles a pacemaker, which is successfully implanted in the chest and which delivers pulses of electricity to the brain. These electrical pulses (which are usually delivered constantly) seem to block the firing of neurons and return the metabolism of the brain into a state of equilibrium. The pacemaker can be accurately programmed and successfully controlled externally through a handheld device.
Although the medical fraternity is not quite sure why the pulses help in resetting the brain, the treatment seems to improve mood and give the patient an overall sense of calm and tranquillity.
There are other targets, the area Cg25, Subthalamic nucleus, and ventral capsule/ventral striatum used as targets to treat depression.
Usually, this procedure is only done at centres which has a high level of expertise. Many of these centres should be also involved in either clinical trials or similar activities so that they have an adequate follow-up of their patients.
In several DBS clinical trials, individuals have reported alleviation of symptoms of depression and a significant improvement in quality of life. Besides depression, DBS is used in the treatment of OCD (obsessive-compulsive disorder), Parkinson’s disease, dystonia, epilepsy, anxiety, and hypertension, among others.
DBS is a viable option for those with chronic, treatment-resistant depression. Usually, doctors recommend extensive courses of psychotherapy as well as drug therapy before opting for DBS because the procedure is invasive, and the success rates vary. Age is not a major issue, but doctors recommend that you need to be in good health to withstand such a major surgery. There are several guidelines for physicians to select appropriate patients who would benefit from DBS for depression. Vera guidelines published in the Indian Journal of psychiatry for defining chronic trips meant refractory, depression, who would benefit from DBS.
Generally, DBS is considered to be a safe procedure. That said, as with any form of brain surgery, complications can always occur. Some of the common complications associated with DBS include Brain haemorrhage, Infection, etc. In a centre with a high level of expertise, these complications can be easily avoided.
Another factor that needs consideration is the requirement for subsequent surgeries. Usually, most centres use a rechargeable battery that lasts for 15 to 25 years. As the current requirements for depression, Deep brain stimulation are very high. It is advisable not to put in non-rechargeable batteries. The patient would also require following up regularly with the physicians for titration of the stimulation parameter to gain maximum benefit out of the surgery. These all factors should be considered before planning for the surgery and discussed with the physician before the operation.
To Sum It Up
DBS is an invasive surgery that has diverse, varying results. Opinions and reviews are mixed in the medical fraternity. The sole thing that most doctors agree on is that DBS must be a distant choice to treat depression and that individuals must thoroughly explore medications as well as psychotherapy before opting for the procedure. You must speak to your doctor to ascertain if DBS is a viable option for you.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341921/ Doshi Paresh K, Arumugham Shyam S, Bhide Ajit, Vaishya Sandeep, Desai Amit, Singh Om Prakash, Math Suresh B, Gautam Shiv, Satyanarayana Rao T S, Mohandas E, Srinivas Dwarkanath, Avasthi Ajit, Grover Sandeep, Reddy Y C Janardhan