Do not read any further if you are squeamish. There will be a lot of blood and detailed descriptions of gruesome neurosurgery.
Ok, now everybody is paying full attention.... How low can you go? We all get low, some of us get depressed, some will get treatment as drugs or psychotherapy, some will get better but a small minority will not respond to any intervention, no matter how many dozens of pills they take or how many hours of counselling they receive. It is known as treatment-resistant depression (TRD). So scientists figured out that the next logical step would be to open up the brain and fix it from the inside!
Brain cells communicate using electro-chemical signals. By implanting electrodes into the brain and sending electrical impulses it is possible to interfere with the functioning of the neuro-circuits that control everything from movements to feelings and thoughts. This is known as Deep Brain Stimulation (DBS). It works by temporarily disrupting electrical activity in the brain regions in order to normalise their functioning. Think about reloading your computer when it freezes in the middle of you preparing the most important report in your career.
What does DBS have to do with severe depression? Researchers have established that depressed patients display abnormal activity in certain brain regions. In the picture below, red box is the area of TOO MUCH activity (ventral pathway) and blue box is the area of TOO LITTLE activity (dorsal pathway) (Maybergh, 1997)
It turns out that these areas operate in a mutually-dependent manner - increase of activity in one region leads to decrease of activity in another. So, here is a clever thing, finally. To fight your depression, neurosurgeons would attach electrodes to the red area marked Cg25 in the overactive region through which electrical impulses will be delivered. And then...
Electric impulse (to the red guys):
- C`mon dudes, you are working overtime here, slow down!
Red guys (some of them):
- Hurray! Annual leave! All expenses paid! But wait, someone has to work! (Shouting to the blue guys) Hey, you lot up there, work for ya money!
Blue guys stretch and yawn, put work suits on and line up in the kitchen for their morning SpecialK and Tropicana. .
Work resumes in the blue department and slows down in the red department. Everybody happy.
Depression:
- Oh, for God`s sake.... (Leaves, slamming the door)
Treatment of severe depression using DBS is a new but very promising approach. Now you know about it too!
References for the curious
Kuhn, J., Grundler, T.O, Lenartz, D., Sturm, V., Klosterkotter, J, Huff, W. (2010) Deep brain stimulation for psychiatric disorders, Deutsches Ärzteblatt International, 107 (7): 105-13
Langevin, J.P (2012), Neuromodulation of the limbic system, Neurology Grand Rounds Lecture Series (podcast), University of Arizona
Lozano, A., Mayberg, H.S., Giacobbe, P., Hamani, C., Craddock, R.C., Kennedy, S.H. (2008)Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression, Bilological Psychiatry, 64 (6): 461-467
Maybergh, H.S (1997) Limbic-cortical disregulation: a proposed model of depression, The Journal of Neuropsychiatry and Clinical Neuroscience, 9: 471–81
And finally...Watch this TED talk if you want to learn more about DBS:
http://www.youtube.com/watch?feature=player_embedded&v=7udZ5ux0dYE
Ok, now everybody is paying full attention.... How low can you go? We all get low, some of us get depressed, some will get treatment as drugs or psychotherapy, some will get better but a small minority will not respond to any intervention, no matter how many dozens of pills they take or how many hours of counselling they receive. It is known as treatment-resistant depression (TRD). So scientists figured out that the next logical step would be to open up the brain and fix it from the inside!
Shut down, restart
Brain cells communicate using electro-chemical signals. By implanting electrodes into the brain and sending electrical impulses it is possible to interfere with the functioning of the neuro-circuits that control everything from movements to feelings and thoughts. This is known as Deep Brain Stimulation (DBS). It works by temporarily disrupting electrical activity in the brain regions in order to normalise their functioning. Think about reloading your computer when it freezes in the middle of you preparing the most important report in your career.
I am depressed, get me out of here!
What does DBS have to do with severe depression? Researchers have established that depressed patients display abnormal activity in certain brain regions. In the picture below, red box is the area of TOO MUCH activity (ventral pathway) and blue box is the area of TOO LITTLE activity (dorsal pathway) (Maybergh, 1997)
The Panto
Electric impulse (to the red guys):
- C`mon dudes, you are working overtime here, slow down!
Red guys (some of them):
- Hurray! Annual leave! All expenses paid! But wait, someone has to work! (Shouting to the blue guys) Hey, you lot up there, work for ya money!
Blue guys stretch and yawn, put work suits on and line up in the kitchen for their morning SpecialK and Tropicana. .
Work resumes in the blue department and slows down in the red department. Everybody happy.
Depression:
- Oh, for God`s sake.... (Leaves, slamming the door)
Applause
Thanks for reading!
References for the curious
Kuhn, J., Grundler, T.O, Lenartz, D., Sturm, V., Klosterkotter, J, Huff, W. (2010) Deep brain stimulation for psychiatric disorders, Deutsches Ärzteblatt International, 107 (7): 105-13
Langevin, J.P (2012), Neuromodulation of the limbic system, Neurology Grand Rounds Lecture Series (podcast), University of Arizona
Lozano, A., Mayberg, H.S., Giacobbe, P., Hamani, C., Craddock, R.C., Kennedy, S.H. (2008)Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression, Bilological Psychiatry, 64 (6): 461-467
Maybergh, H.S (1997) Limbic-cortical disregulation: a proposed model of depression, The Journal of Neuropsychiatry and Clinical Neuroscience, 9: 471–81
And finally...Watch this TED talk if you want to learn more about DBS:
http://www.youtube.com/watch?feature=player_embedded&v=7udZ5ux0dYE
Interesting, but I wouldn't want to try it on myself :)
ReplyDeleteIf it really is so efficient, it may help a lot of people with this illness, but how accurate treatment should be!
You are absolutely right, Elena. Positioning of the electrodes needs to be very precise. Part of the problem is that all brains are different and to determine exact location of the "malfunctioning" region is extremely hard. That`s why only the best of the best become neurosurgeons!
ReplyDelete