NEW YORK (AP) — Emily Hollenbeck lived with a deep, recurring depression that she compared to a black hole; Here gravity was so strong and his limbs were so heavy he could barely move. She knew the disease could kill her. She took the lives of both her parents.
He was willing to try something extreme: having electrodes implanted in his brain as part of an experimental therapy.
Researchers say the treatment, called deep brain stimulation, or DBS, could eventually help many of the nearly 3 million Americans like him who have depression resistant to other treatments. It has been approved for conditions such as Parkinson’s disease and epilepsy, and many doctors and patients hope it will soon become more widely available for depression as well.
The treatment delivers targeted electrical impulses to patients, similar to a pacemaker in the brain. Although progress has been temporarily halted by two large studies showing no advantage to using DBS for depression, and some scientists continue to voice concerns, a growing body of new research is on the way, with more on the way.
Meanwhile, the Food and Drug Administration has agreed to expedite its review of Abbott Laboratories’ request to use DBS devices for treatment-resistant depression.
“I was very surprised at first because the concept seems so intense. For example, brain surgery. There are wires embedded in your brain,” said Hollenbeck, who is part of ongoing research at Mount Sinai West. “But I also felt like I had tried everything at that point and was desperate for an answer.”
“NOTHING WAS WORKING”
Hollenbeck suffered from symptoms of depression as a child growing up in poverty and occasional homelessness. But his first major crisis occurred at university after his father’s suicide in 2009. He suffered another blow during his tenure as Teach for America, leaving him virtually immobilized and worried that he would lose his job in the classroom and fall back into poverty. He went to the hospital.
“I finally had some sort of on-off pattern,” he said. After responding to the medication for a while, the condition recurred.
Even after losing her mother during her final year of graduate school, she managed to earn a doctorate in psychology. But the black hole always returned to suck him in. He said he sometimes thought about ending his life.
He said he exhausted all options, including electroconvulsive therapy, when a doctor told him about DBS three years ago.
“Nothing else was working,” he said.
He became one of only a few hundred people treated with DBS for depression.
Hollenbeck underwent brain surgery calm but alert. Dr., who directs the Mount Sinai Neuromodulation Center. Brian Kopell placed thin metal electrodes in a region of his brain called the subcallosal cingulate cortex, which regulates emotional behavior and is associated with feelings of sadness.
The electrodes are connected by an internal cable to a device that is placed under the skin on the chest, controlling the amount of electrical stimulation and delivering continuous low-voltage pulses. Hollenbeck calls this “constant Prozac.”
Doctors say stimulation helps because electricity speaks the brain’s language. Neurons communicate using electrical and chemical signals.
Kopell said that in normal brains, electrical activity reflects unhindered in all areas, like a kind of dance. Depressed dancers get stuck in the emotional circuitry of the brain. He said DBS “breaks the circuit” and allows the brain to do what it would normally do.
The impact is almost immediate, Hollenbeck said.
Psychiatrist Dr. “The first day after the surgery, he started to get rid of that negative mood and heaviness,” said Martijn Figee. “I remember him telling me that he was able to enjoy Vietnamese food for the first time in years and really taste the food. “She started decorating her house, which had been completely empty since she moved to New York.”
According to Hollenbeck, the most profound change was enjoying music again.
“When I was depressed, I couldn’t listen to music. “It sounded and felt like I was listening to radio static,” he said. “Then, on a sunny summer day, I was walking down the street listening to a song. I just felt this aliveness, ‘Oh, I want to walk more, I want to go do something!’ And I realized I was getting better.”
I wish therapy was there for parents too.
HISTORY OF TREATMENT
The path to this treatment was led by neurologist Dr. It dates back two decades, when Helen Mayberg pioneered promising early research.
But setbacks followed. Large studies initiated more than a dozen years ago showed no significant difference in response rates between treated and untreated groups. Dr. is a psychiatrist at the University of California, San Francisco, and also conducts research on DBS and depression. Katherine Scangos listed several reasons for this: The treatment was not personalized, and the researchers looked at the results over several weeks.
Some later studies showed that patients with depression received stable, long-term relief from DBS when observed over years. Overall, DBS for depression across different brain targets is associated with an average response rate of 60%, according to a 2022 study.
Treatments tested by various teams are now much more personalized. Mount Sinai’s team is one of the most prominent in the United States researching DBS for depression. There, a neuroimaging specialist uses brain images to find the exact spot where Kopell would place the electrodes.
“We have a blueprint, a blueprint for exactly where to go,” said Mayberg, a pioneer in DBS research and founding director of the Nash Family Center for Advanced Circuit Therapy at Mount Sinai. “Everyone’s brain is a little different, just like people’s eyes are a little bit further apart or their nose is a little bigger or smaller.”
Other research teams also tailor treatment to individual patients, but their methods are slightly different. Scango and his colleagues study a variety of targets in the brain, providing alerts only when needed for severe symptoms. The best treatment may be a combination of approaches, he said.
As teams continue to work, Abbott is launching a large clinical trial this year ahead of a potential FDA decision.
“The field is advancing pretty quickly,” Scangos said. “I hope we will get approval soon.”
However, some doctors are skeptical about this situation, noting possible complications such as bleeding, paralysis or infection after surgery.
Retired professor of psychiatry from the University of Pennsylvania, Dr. Stanley Caroff said scientists still don’t know exactly the pathways or mechanisms in the brain that cause depression, so it’s difficult to choose where to stimulate. Selecting the right patients for DBS is also difficult, he said, and acknowledged that successful treatments for depression are available.
“I believe from a psychiatric standpoint the science is not there,” he said of DBS for depression.
WE ARE MOVING FORWARD
Hollenbeck acknowledges that DBS is not a panacea; he still takes medication for depression and needs ongoing care.
He recently visited Mayberg in his office and discussed recovery. “It’s not about being happy all the time,” the doctor told her. “This is about making progress.”
This is what researchers are currently working on; How to track progress.
Recent research by Mayberg and others in the journal Nature has shown that it is possible to get a “read” on how someone is doing at any given time. Analyzing the brain activity of DBS patients, researchers found a unique pattern reflecting the recovery process. This gives them an objective way to observe how people are recovering and to distinguish between impending depression and typical mood swings.
Scientists are confirming these findings using newer DBS devices in a group of patients, including Hollenbeck.
He and other participants are largely doing their part at home. He gives researchers regular brain recordings by logging into a tablet, placing a remote control over the pacemaker-like device in his chest, and sending the data. He answers questions that arise about how he feels. She records a video that is later analyzed for things like facial expression and speech.
Occasionally, he heads to Mount Sinai’s “Q-Lab,” an immersive environment where scientists conduct quantitative research collecting all kinds of data, including how he moves through a virtual forest or circles in the air with his arms. Like many other patients, he moves his arms faster now that he is better.
Data from recordings and visits is combined with other information, such as events in his life, to chart how he is performing. This helps guide doctors’ decisions, such as whether to increase the electrical dose (which they have done before).
Recently, Hollenback moved her collar and combed her hair to the side, revealing scars from DBS surgery on her chest and head. To him, these are signs of how far he has come.
She wanders around the city, walks in the park, and visits the libraries that were her childhood refuge. He no longer worries that normal life challenges will trigger a devastating depression.
“The stress can be quite extreme at times, but even on a physical level I can see and remember that I will be okay,” she said.
“I’m sure I wouldn’t be alive today if I hadn’t had DBS.”
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