How clinical depression is being successfully treated through implant

How clinical depression is being successfully treated through implant

[Music] subscribe to our youtube channel and press the bell icon to get the latest updates [Music] major depressive disorder mdd or clinical depression as it’s more commonly called is a medical condition and is a severe mood disorder that affects behavior and psychological and physiological functions even things like sleep and ability to work it can affect a person’s daily life causing a perennial and persistent feeling of sadness or loss of interest in everything around them including activities that provide pleasure such as indulging in a favorite hobby or even sex there’s feelings of guilt and agitation and restlessness sleep and appetite disruption inability to think clearly and it’s really not something that people can just snap out of with their willpower or by exercising or getting enough sleep mdd is actually quite common it is more common than we think it is and it is often undiagnosed but it can be treatable with medicines and drugs sometimes some forms of mdd can be resistant to treatment with drugs there are over 200 to 250 million people in the world globally affected with various levels of depression and it is thought that nearly one third of these people are resistant to all kinds of available treatments and drugs now researchers in the university of california san francisco have made a breakthrough in treating the condition using a surgical implant that delivers electrical stimulus and impulses to precisely targeted locations in the brain these kind of implants have been done before and work in a very similar manner but the results are highly variable and they change from person to person they are in fact even dependent on the person’s current mode and emotional state this process these kind of treatments are called deep brain stimulation and it is actually quite a promising therapy it has been tried for various other mental disorders like ocd and even bipolar disorder but these researchers now what they’ve done is that they have shown the ability to treat severe treatment resistant depression over long term in a personalized manner for individual patients this trial was done on a single patient by the researching team a patient who had childhood onset of depression and had been struggling throughout her life the device works by identifying neural biomarkers that trigger the therapy or electrical pulses when the severity of an mdd symptom goes up the researchers used the person’s own physiological activity and emotional state and selectively triggered stimulation to the brain this process is called closed loop stimulation as opposed to open loop stimulation where irrespective of how the patient is feeling treatment is provided in the form of electrical pulses closed loop seems to work better as this trial indicates and we will see why to perform closed loop stimulation there needs to be a parameter that needs to be checked and monitored to identify the patient’s mental and physiological state this is a biomarker that is indicative of mdd symptoms before this research such a biomarker had been unidentified this team now through their experiments with this one person have successfully identified a biomarker and used it for closed loop therapy with good results that seem to have successfully treated the patient’s depression the research was led by dr catherine skangos the patient was a 36 year old female patient who is known by her first name only sarah she had been previously unresponsive to several antidepressant therapies and electroconvulsive therapy or ect where the brain is stimulated by electrodes under anesthesia but is open loop and not dependent on the mental or physiological state of the patient so the objective for this research team was to treat sarah to do this they wanted to identify a biomarker in her brain that could tell whenever her mdd symptoms were spiking and only when they spike they wanted to provide electrical impulses to very targeted sections of the brain from the implant that is in her brain so to identify this biomarker for the symptoms the team first performed a stimulus response mapping exercise of the entire brain and neural circuitry and pathways using electrodes they notice diminished responses in some areas that are indicative of various symptoms of depression they recorded sarah’s neural and brain activity continuously for 10 days to go about identifying when she’s in a low symptom state with less severe effects and in a high symptom state with increased feelings of depression and suicidal thoughts they mapped many parts of her brain and the key parts involved in other mental illnesses as well these are where electrodes are usually placed bilaterally or on both sides these are the orbital frontal cortex which sits right above the eyes and is involved in senses emotions and memory there’s the amygdala which is the main center where emotions and emotional responses are processed the hippocampus which plays a key role in memory and the process of learning the cingulate cortex which is also involved in information processing emotion processing learning and memory and finally the ventral capsule ventral striatum or the vcbs complex the ventral capsule and striatum have both been used in targeted treatments for many mental disorders such as ocd and bipolar disorder this is because this portion of the brain is involved in reward pathways it is what processes and mediates reward reinforcement motivations and the entire reward system pathway the researchers used a commercially available neural interface device it is one that can both sense brain activity and also provide electrical stimulation sarah was a patient with severe mdd her doctor had in fact told her family that it was even unsafe for her to live alone by herself because of the extent of her suicidal thoughts and depression she was unable to hold down a job and she had tried every medical treatment that was available including medication electroconvulsive therapy magnetic stimulation and more then she enrolled in this experimental therapy as the first and only participant she was fitted with the small device the size of a matchbox and that was implanted in her brain the device monitored her neural activity throughout the day and anytime it sensed spikes in mdd symptoms it would fire of electrical impulses to targeted areas in bursts of 6 seconds mdd or clinical depression can be assessed and quantified on various standardized scales that are available today on the one called the montgomery asberg depression rating scale or the mad rs scale which ranges from 0 to 60 sarah score was at 33 when the trial began on the scale anything beyond 34 is thought to be very severe depression and at the beginning sarah had a score of she told the new york times that when the researchers were trying out different stimulations in different parts of her brain to map her entire circuitry there was one moment where she felt like she was suddenly very happy for the first time she spontaneously laughed out loud and smiled and described her feelings as being in front of a warm cozy fire this occurred when pulses were sent to the vcds complex and the amygdala she had this treatment for about two months first on average she had about 460 detections of elevated symptoms and she was given a maximum of 300 electrical stimulations 12 days after her treatment began her individual score on the mad rs scale dropped from 33 to 14. and a few months later it fell below 10 which on the scale is considered to be very mild she had gone into remission successfully her scores on other standardized depression tests also started to drop very steeply and very quickly in a matter of just days the electrical stimuli were given to the amygdala and the ventral striatum and her device pulsed her with a six second burst of electricity every time the symptoms bite to confirm that their biomarker assessment was correct and it is the treatment that was helping sarah the researchers blinded the trial as well that is at one point sarah did not know if her device was switched on or switched off in her brain but whenever it was off she started having worse episodes of depression and more severe suicidal thoughts but now she has been under treatment for over a year and the number of impulses that her brain has needed has come down from the maximum of 300. she doesn’t need all of them on a daily basis and she is also of course able to tell when the device is on or off because she can recognize and process her own thoughts and when it is on she reports feeling alert and present and taking in the moment which is hugely positive she even says that she can see colors more vividly and overall feels happier however this is still very very very early findings the trial has been done on only a single person the long-term effects how long these effects would sustain is unknown will sarah eventually be able to get off the machine or will she be on it for her whole life will the same method uphold and work for other people with other kinds of depression can it also work for other kinds of mental disorders we don’t know yet but these findings are hugely promising and they hold a lot of promise for future trials which would make targeted therapies for mental health more practical more accessible and more successful for our larger population [Music] [Applause] [Music] you

American scientists have identified a biomarker in the brain that can indicate spiking in symptoms of treatment-resistant depression. In a trial with a single patient, a device was implanted in the brain that monitored for such activity and fired targeted electrical pulses only when required. This resulted in successful treatment of clinical depression. ThePrint’s SandhyaRamesh explains these early findings.
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Supplementary reading:
Closed-loop neuromodulation in an individual with treatment-resistant depression https://www.nature.com/articles/s41591-021-01480-w

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A ‘Pacemaker for the Brain’: No Treatment Helped Her Depression — Until This https://www.nytimes.com/2021/10/04/health/depression-treatment-deep-brain-stimulation.html?smid=tw-nytimesscience&smtyp=cur
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