Brain Stimulation Therapy Eases Tough-to-Treat Depression

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About one-fifth of people suffering from depression get no relief from psychotherapy and/or medication. About 70 percent of these "non-responders" can, however, benefit from electroconvulsive therapy. But many of these will later relapse, and there's still the group of individuals who fail all treatments.

For this trial, a dozen patients with refractory depression were randomly assigned to receive 8 weeks of cortical stimulation of the left dorsolateral prefrontal cortex (DLPFC) area of the brain, which appears to play a role in depression, or to get "sham" stimulation. Those receiving the sham treatment were then switched over to active therapy.

Stimulation was delivered via an investigational epidural cortical stimulation system, developed by Northstar Neuroscience, which funded the study. One of the authors is a consultant to the company.

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On average, participants experienced an improvement of about 25 percent to 30 percent on different measures of both depression and quality of life.

Three people went into complete remission.

"That may not sound like a lot, but to get any response at all in an otherwise extremely refractory group is extremely promising. This is a potentially less invasive therapy," said Eskandar, who is an attending neurosurgeon at Massachusetts General Hospital and associate professor of neurosurgery at Harvard Medical School, both in Boston. "We also learned that improving the electrode position and giving more current got better effects, so, in the future, we have a pretty good idea of how to improve on this."

The group is now organizing a larger trial to study the potential of the method.

A second study also being presented at AANS found that a type of deep brain stimulation known as globus pallidus internus (GPi) deep brain stimulation was effective in relieving symptoms of primary dystonia in children.

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