About 33% of people with depressive symptoms experience treatment-resistant depression, meaning they don’t receive significant relief from common therapies like medication or counseling. Doctors have used deep brain stimulation to treat movement disorders, such as Parkinson’s disease, and seizure disorders like epilepsy for years. Now, experts at Baylor St. Luke’s Medical Center and Baylor College of Medicine are researching whether this revolutionary technology can also help those with treatment-resistant depression.
Deep brain stimulation is a procedure that begins with a surgeon placing electrodes in select areas of the brain, as well as an implantable pulse generator (IPG) under the skin in the upper chest. Much like a pacemaker, this device sends pulses of custom, adjustable parameters to the electrodes in the brain.
Researchers have pinpointed areas in the depressed brain that could benefit from stimulation. They’ve noted two particular places: the subgenual anterior cingulate cortex (sgACC) and the ventral capsule/ventral striatum (VC/VS).
In the brain of a person without depression, the sgACC and VC/VS are partially responsible for controlling the response to a perceived reward. Essentially, the VC/VS receives sensory input and determines whether there is a potential benefit for completing a task. If this area senses a reward, it sends information to the sgACC, which encourages the person to perform an action. It keeps them excited throughout the whole task, so they don’t lose motivation halfway through.
In the brain of a person with depression, the sgACC may be smaller or may have lesions on it, while the VC/VS has a much more limited response to external stimuli. This means that people with depression might not perceive common rewards as something worth earning. If it does find an enticing benefit, they might feel an initial increase in motivation but may not be able to maintain this interest long enough to complete a task.
To put this into context, the brain of a person with depression might not be able to experience the pleasure associated with spending time with friends. Therefore, that person won’t be motivated to do so.
With this understanding of the functioning of the sgACC and VC/VS in the brains of people with treatment-resistant depression, researchers are looking to place the electrodes in these two areas. With custom stimulation traveling to the sgACC and VC/VS, they hope to increase responsiveness to external stimuli as well as maintain a steady state of excitement.
“The proposed studies will investigate the feasibility and safety of using a next-generation DBS system, the Boston Scientific Vercise DBS system, to ‘steer’ stimulation simultaneously to two different brain regions implicated in treatment-resistant depression that may lead to new and better treatments for this and other severe neuropsychiatric disorders,” said Baylor St. Luke’s Medical Center neurosurgeon Dr. Sameer Sheth, associate professor of neurosurgery at Baylor College of Medicine and one of the principal investigators of the deep brain stimulation for depression clinical trial.
If you’re interested in learning more about deep brain stimulation and other innovative therapies for a variety of neurological conditions, schedule an appointment with a St. Luke’s Health neurologist to begin your healthcare journey with Houston’s leaders in neuroscience.
Baylor College of Medicine | Deep Brain Stimulation for Depression Using Directional Current Steering, Individualized Network Targeting (H-43036)
St. Luke's Health Newsroom | BRAIN Initiative to support Baylor doctors studying the neurocircuitry of depression
NCBI | The Subgenual Anterior Cingulate Cortex in Mood Disorders
PNAS | A role for primate subgenual cingulate cortex in sustaining autonomic arousal
NCBI | Chapter 11Neuroanatomy of Reward: A View from the Ventral Striatum
NCBI | Target-specific deep brain stimulation of the ventral capsule/ventral striatum for the treatment of neuropsychiatric disease
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