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Published online 23 July 2008 | Nature | doi:10.1038/news.2008.970
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Brain electrodes tackle severe depression
Trial shows success for 'deep brain stimulation' technique.
Severely depressed patients who do not respond to conventional therapy may be helped by deep brain stimulation (DBS), according to the most-extensive study to date of the experimental procedure.
In a clinical trial in Toronto, Canada, 12 out of 20 patients who had stimulating electrodes placed in a brain area called the subcallosal cingulated gyrus showed significant improvement in their depression, with seven of them going into full remission.
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I find this study astonishing. But it does raise some questions. I think it would be of crucial interest to continue to follow these patients and see how they react to the DBS on a long term basis. It would tell us if the benefits persist and if there are consequences. Catia
As a sufferer of unipolar depression for most of my adult life I am very gratified that Nature is presenting articles on the devastating effects of this disease. The famous author, William Styron, aptly described it in his book, "Darkness Visible," as "Despair beyond despair."
To study or research this kind of psychiatric disease is really frustrating ,because we always don't know what is the very first origin causing it. We usually use some chemical receptors to represent a disease, like NMDA receptor relative to Bipolar.In other words, we usually try to use a corner to represent the whole body. Truly as this article noticing "no-one knows which of the targets within these circuits will eventually prove to be the most optimal", we don't know which target benefits most.In fact, we eventually don't know what cause it. I think that my botheration will persisted probably until we have a clear understanding of the routs and mechanism.
Although these results concerning area 25 DBS are truly encouraging, the fact that some patients do not seem to respond at all should make us wonder about a better search for more robust prediction and selection criteria. The problem is that once the electrodes are in place in the brain we cannot go back to ECT or rTMS (rapid transcranial magnetic stimulation). Although the first results of this rTMS procedure were not always consistently positive recent studies have shown that misalignment of the magnetic coil could often (40% errors) be held responsible for part of the outcome variance and this could be vastly improved pure technically by coupling the "old" rTMS stimulator to a genuine neuronavigation system cfr ANT EEG systems (http://www.ant-neuro.com/products/visor/) and even to a robot guided stimulation system. This makes it indeed more expensive but provides a much better stimulation robustness and quality especially in repetitive therapeutic stimulations. Pilot studies (fi at Univ Ulm, Germany ) have indeed shown very promising results in therapy resistent depression ! These results were presented in jan 2008 at the Neuromeeting Beaune France and will no doubt be further explored. Let us not forget that rTMS is a non invasive and non traumatic method in contrast to DBS that will always be limited to a small number of patients. As both the numbers of depressed patients and therapy resistent patients are huge, DBS will never be able to help them all. PS A nice review on rTMS was published in Nature( Nature Reviews Neuroscience 8, (01 Oct 2007), doi: 10.1038/nrn2169-c2). So lets us help and support the DBS community but especially promote more vigorously the deployment of cornerstone studies on the therapeutic potency of the new atauumatic rTMS initiative especially in its new form that is in combination with robotica and neuronavigation. Dr. G. Otte