MELISSA BLOCK, host:
Another story about mental illness now, this one dealing with depression. For about 10 percent of people with severe depression, no available treatments work, not anti-depressant medicines, not psychotherapy, not even electroshock therapy. But an experimental treatment first tried in Canada has lifted the unremitting deep depression of a handful of patients. It involves surgery that implants electrodes in the brain. As NPR's Michelle Trudeau reports, more experimental surgeries are planned in the United States.
MICHELLE TRUDEAU reporting:
Robert Matt's depression began 15 years ago in his early 20s.
Mr. ROBERT MATT: It would be periods where I mostly would withdraw, and I would find it very difficult to focus on work, things around the house, relationships. And it slowly progressed till probably 10 years ago when I really started having trouble with coping with my life.
TRUDEAU: His depression became so debilitating that he stopped work, couldn't leave the house, was suicidal, stayed in bed for years. He tried multiple anti-depressant medicines, different talk therapies and, as a last resort, had dozens of electroshock treatments, but nothing worked. Then he heard about a new but untested treatment for intractable depression that neurologist Helen Mayburg, then at the University of Toronto, was offering.
Mr. MATT: And I met with her, and she thought that she could help me, so I said, `Sure, let's do it.'
TRUDEAU: It was a type of brain surgery called deep brain stimulation, where electrodes are implanted deep inside the brain that produce a constant weak electrical stimulation to a target area of the brain. It had been used previously to treat Parkinson's disease, but this was the first time it was being tried in depressed patients. Researcher Helen Mayburg.
Dr. HELEN MAYBURG (Neurologist): The first patient was operated on in end of May 2003.
TRUDEAU: The patient was given just a local anesthetic. Then the neurosurgeon drilled two small holes into the top of the skull and threaded a slim wire the size of a human hair into the brain. Mayburg describes the procedure.
Dr. MAYBURG: So the patients are now wide awake. They're instructed that their job--and they have the most important job--is to tell us if anything happens, no matter how trivial. And you have to remember, there's never been an electrode of this type placed in this part of the brain.
TRUDEAU: This part of the brain called area 25 plays a critical role in depression, Mayburg's previous research had shown. So she theorized that aiming a mild but constant electrical pulse directly into area 25 might recalibrate the area back to normal functioning. Here's patient Robert Matt's recollection of the surgery.
Mr. MATT: When they were putting the electrodes in and they turned them on to test them, I actually had some weird sensations. Like, the first thing that happened was the room brightened up. It was like someone opened the shades. The room got brighter, and the colors got brighter. It was really, really strange.
TRUDEAU: Helen Mayburg recounts the response of one of her female patients as the electrical current was increased.
Dr. MAYBURG: Then all of a sudden she describes, `What did you do? I suddenly have a tremendous sense of calmness.' She goes, `It's very hard to describe, but it's a sense of relief.' We immediately, without telling her what we were doing, turned the voltage down, and she suddenly reports, `Gee, did you change something because that sensation has now gone away?'
TRUDEAU: Only when the electrodes were activated specifically in brain area 25 did the patients report such sensations of immediate relief.
Dr. MAYBURG: This was actually almost seeing depression turn off. In fact, one patient said it best. He said, `The void that just so totally consumes me seems to be gone.'
TRUDEAU: Mayburg was astonished listening to her patients as the effect of DBS became evident.
Dr. MAYBURG: To have patients express this spontaneously when you yourself, implanting an experiment, have no idea what actually will happen, it's beyond anything I've ever experienced as a physician with anything I've ever done with any patient.
TRUDEAU: After the surgery the electrodes are left in area 25, and a wire is threaded out of the skull, under the skin, to the front of the chest to a tiny power pack, which controls the low-voltage electrical stimulation to area 25 and can be adjusted. It's like a pacemaker for the depressed brain.
Mayburg monitored her six patients for months after surgery. Two of them did not improve, but four did dramatically.
Dr. MAYBURG: At six months the four patients that responded to this treatment were actually near remission, and several of them were in remission, meaning they weren't just better. They were well.
TRUDEAU: Lives brought back to normal after years of disability. Here's patient Robert Matt.
Mr. MATT: I knew it was working. Like, I instantly could focus on things like I hadn't for years. It was quite scary actually because I guess part of me believed it wouldn't work.
TRUDEAU: Mayburg also took brain imaging scans of the four patients whose depression had lifted. Their brain activity was much more back-to-normal functioning than before the surgery. So DBS was successful in this first experimental trial, but that's in just four patients. So the work needs to be replicated, says Mayburg, now at Emory University. So she's recruiting new patients with intractable depression to see if deep brain stimulation will help them. For NPR News, I'm Michelle Trudeau.
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