Deep brain stimulation could become a useful way to treat
depression and obsessive-compulsive disorder (OCD), results of two of the
largest and longest studies revealed.
OCD is a psychiatric anxiety disorder marked by recurrent
and persistent thoughts and impulses, such as uncontrollable and repeated hand
washing.
Deep brain stimulation is used for some people with
Parkinson’s disease, essential tremor and dystonia.
According to Dr. Ali Rezai, head of neurosurgery at the
Cleveland Clinic’s Center for Neurological Restoration, who led the studies,
deep brain stimulation helped the most severely depressed patients improve
significantly.
Researchers from Butler Hospital-Brown Medical School,
Massachusetts General Hospital
and Harvard medical school were also involved in the depression study.
Eight of the 16 patients participating in one of the studies,
previously diagnosed as having depressive disorder, showed at least 50 percent
improvement in depression scores after one-year follow-up period, Dr. Rezai said
during an interview on Monday, MedPage Today reported.
The results of the study, called Deep Brain Stimulation for
the Treatment of Depression: Long Term Outcomes from a Prospective Multi-Center
Trial, will be presented by Dr. Rezai on Tuesday during the 76th Annual Meeting
of the American Association of Neurological Surgeons in Chicago. Medtronic Inc. supported the study.
The patients were treated with Medtronic’s deep brain
stimulation device. The “brain pacemaker” is implanted in the chest, with leads
that send electrical impulses to parts of the brain that are functioning
abnormally. The impulses block the abnormal activity in the brain, which causes
a variety of symptoms, such as pain, tremors, movement problems, as well as obsessions,
moods and anxieties associated with psychiatric disorders.
Before the study, the patients had severe and disabling
major depression lasting at least five years without response to at least three
classes of antidepressants titrated to the highest tolerated doses.
“This research substantiates our earlier findings, which
indicate that bilateral DBS of the anterior limb of the internal capsule holds
promise and hope for select patients suffering from severe and treatment
resistant major depression. [Responders] had significant improvement in quality
of life, returning back to work, getting engaged, dating,” Dr. Rezai said.
The brain pacemaker, manufactured by Medtronic Inc., was
also effective in treating OCD, Dr. Rezai said. The trial included 26 patients
who were followed for three years.
There were no major adverse effects such as hemorrhage or
infection. Just one patient reported discomfort from the leads, which resolved
after they were relocated. Two patients had a return of depressive symptoms and
suicidal ideation when their pulse generators were accidentally turned off, but
symptoms improved once they were restarted, Dr. Rezai said.
He also added that
the next step would be a randomized, controlled trial.