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STIMULATION OF BRAIN'S 'REWARD' CENTER CAN HELP WITH TREATMENT-RESISTANT
DEPRESSION

By Corrie Pelc on August 26, 2022 — Fact checked by Ferdinand Lali, Ph.D.
Share on PinterestWhich brain area should deep brain stimulation target in order
to improve treatment-resistant depression? Researchers may have found an answer.
Image credit: artpartner-images/Getty Images.
 * About 30% of people with major depressive disorder (MDD) develop
   treatment-resistant depression.
 * Researchers from UTHealth Houston say deep brain stimulation applied to
   certain areas of the brain may help treat it.
 * The research team found that depression in 8 out of 10 treatment-resistant
   patients decreased by at least 50% after deep brain stimulation.

About 30% of peopleTrusted Source receiving care for major depressive disorder
have treatment-resistant depression. Treatment-resistant depression occurs when
a person does not respond to at least two different antidepressant medications.

Treatment options for this form of depression include additional medications,
psychotherapy, and brain stimulationTrusted Source.

Now, a team of researchers from UTHealth Houston has found that delivering deep
brain stimulation to the areas of the brain related to reward and motivation may
help alleviate treatment-resistant depression.

This study recently appeared in the journal Molecular PsychiatryTrusted Source.


WHAT IS TREATMENT-RESISTANT DEPRESSION?

The World Health Organization (WHO) ranks depression as the most common illness
in the worldTrusted Source, affecting about 3.8% of the global population.

Major depressive disorder or clinical depression is a mood disorder that impacts
a person’s daily life. Symptoms of depression include:

 * fatigue
 * sleeping issues
 * concentration problems
 * anxiety and/ or nervousness
 * changes in appetite
 * anger and/ or irritability
 * thoughts of self-harm and/ or suicide.

The treatment for depression normally includes medication, psychotherapy, or a
combination of both. Medications for depression can include
antidepressantsTrusted Source, antipsychoticsTrusted Source, and mood
stabilizersTrusted Source.

If a person receiving treatment for depression does not respond to at least
twoTrusted Source different antidepressant medications, they may have
treatment-resistant depression.

Current treatments for this include:

 * augmentation therapyTrusted Source, where a doctor prescribes an
   antidepressant medication and a second medication that is usually not an
   antidepressant
 * psychotherapy
 * brain stimulation
 * novel treatmentsTrusted Source, such as psilocybin or anti-inflammatory
   drugsTrusted Source.

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Improve your quality of life with the support of BetterHelp's licensed
therapists. Get therapy when you need it over phone, video, or chat.

LEARN MORE

WHAT IS DEEP BRAIN STIMULATION? 

Deep brain stimulationTrusted Source is a neurosurgical treatment where
electrodes are implanted into the brain. The electrodes send out electrical
signals to the brain, helping to change and correct the way in which it
operates.

Over 160,000Trusted Source people globally have received deep brain stimulation
treatment for both neurological and non-neurological issues.

Deep brain stimulation is commonly used to treat movement disorders such as
Parkinson’s disease and dystonia. Researchers have also studied it as a
potential treatment for treatment-resistant depression.

A systematic review of clinical outcomes published in 2014 found that 40-70% of
people with treatment-resistant depression treated with deep brain stimulation
showed an improvement of over 50% in their symptoms.

“Unfortunately, despite all resources we have to treat depression and even
treatment-resistant depression, not all patients respond to them,” explained Dr.
João de Quevedo, professor in the Louis A. Faillace, MD, Department of
Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth
Houston, and a co-author of the study.

“Invasive treatment strategies including deep brain stimulation come to address
the unmet needs of this treatment-resistant depression subpopulation,” he added.

TARGETING THE BRAIN’S REWARD AND MOTIVATION CENTER

According to Dr. de Quevedo, the purpose of this research study was to show the
efficacy of their surgical approach in improving depressive symptoms of people
living with treatment-resistant depression.

“Despite [having] a rationale for choosing this specific target to land the
electrodes, we need further evidence on which brain structures are activated
downstream,” he told Medical News Today. “It generates a kind of roadmap of
additional targets for treatment.”

During the study, Dr. de Quevedo and his team examined applying deep brain
stimulation to the superolateral branch of the medial forebrain bundleTrusted
Source in the brain. This area of the brain is related to reward and motivation.

Researchers applied deep brain stimulation to this particular area of the brain
in 10 patients. Using PET scansTrusted Source conducted at 6 months and at 1
year following deep brain stimulation treatment, researchers found metabolic
brain changes in 8 of the 10 patients, indicating a decrease in a patient’s
markers of depression of at least 50%.

“We are paving the road that will lead us to large-scale clinical trials and
therefore FDA approval,” Dr. de Quevedo stated. “Our proof-of-concept study is a
starting point, not the end.”


‘EXCITING’ POTENTIAL NEW THERAPY

Dr. Jean-Philippe Langevin, neurosurgeon and director of Restorative
Neurosurgery and Deep Brain Stimulation Program for Pacific Neuroscience
Institute at Providence Saint John’s Health Center in Santa Monica, CA, said
this new research is “exciting” as a potential new therapy for an area where
there are currently not many options.

“The majority of patients with depression are going to get better with
medication or psychotherapy, but there’s a small group that does not improve,”
he explained to MNT.

“And so for those patients,” he added, “there’s not a whole lot of options out
there. It was nice to see that in another line of evidence that perhaps
neurosurgery could offer some help in the future.”

Dr. Langevin said clinicians are now discovering that patients with depression —
and in particular, treatment-resistant depression — have anomalies or abnormal
ways in which the brain is functioning or processing emotion.

“It could be that in those patients perhaps it’s a condition where the brain was
wired that way, or sometimes it could be that events or medical conditions in
life happen and change the way your brain is wired slightly and make it very
difficult to get out of that feeling or those symptoms of depression,” he
explained.

> “In deep brain stimulation, we can alter the way the brain works in a more
> focal way. You can target those areas of the brain that are either too active
> or not active enough, and then switch their activity slightly or modulate it
> in a way that’s more conducive to proper emotional processing.”
> 
> – Dr. Jean-Philippe Langevin

When asked what he would like to see in future research, Dr. Langevin mentioned
that while there has been other research examining the use of deep brain
stimulation for treatment-resistant depression in different ways, he would like
to see a more individualized approach.

“One patient may benefit from [deep brain stimulation] in one specific area
versus another one and another area,” he noted. “That could explain why some
patients [respond] in those trials, whereas other ones may not be responding as
well.”

“In general, I think what we need is continuing to pursue the work with larger
studies to prove whether or not we’re on the right track,” Dr. Langevin added.


 * Mental Health
 * Neurology / Neuroscience
 * Psychology / Psychiatry

By Corrie Pelc on August 26, 2022 — Fact checked by Ferdinand Lali, Ph.D.




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