Woman successfully treated for depression with electrical brain implant | Depression | The Guardian 05/10/2021 14(37

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depression with electrical brain implant

Hannah Devlin Science

correspondent
@hannahdev
Mon 4 Oct 2021 16.00 BST

Sarah, the 36-year-old patient in the clinical trial, at an appointment with Katherine Scangos, assistant professor
of clinical psychiatry at the University of California San Francisco. Photograph: Maurice Ramirez

A woman with severe depression has been successfully treated with an

experimental brain implant in a “stunning” advance that offers hope to those
with intractable mental illness.

The device works by detecting patterns of brain activity linked to depression

and automatically interrupting them using tiny pulses of electrical
stimulation delivered deep inside the brain.

The 36-year-old patient, Sarah, said the therapy had returned her to “a life
worth living”, allowing her to laugh spontaneously for the first time in five
years.

Although the therapy has been tested in only one patient – and would only
ever be suitable for those with severe illness – the success is seen as hugely
significant. It is the first demonstration that the brain activity underlying the
symptoms of mental illness can be reliably detected and reveals that these
brain circuits can be nudged back into a healthy state, even in a patient who
has been unwell for years.

“We haven’t been able to do this kind of personalised therapy previously in

psychiatry,” said Katherine Scangos, an assistant professor of clinical
psychiatry at the University of California, San Francisco (UCSF), who led the
work. “This success in itself is an incredible advancement in our knowledge
of the brain function that underlies mental illness.”

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Woman successfully treated for depression with electrical brain implant | Depression | The Guardian 05/10/2021 14(37

Patterns of activity linked to depression are detected and interrupted

through electrical stimulation

Deep brain stimulation device

Sensing happens Stimulation

in the amygdala happens in the
area ventral striatum

Source: © Copyright 2021 UCSF all rights reserved, Nature Medicine

Prof Rupert McShane, a consultant psychiatrist and associate professor at

Oxford University, who was not involved in the trial, said: “This is a stunning
demonstration … which points to a way of examining the biology of the
abrupt slumps into despair that can be so destructive.”

Between 10% and 30% of people with depression do not respond to at least
two drug treatments – equivalent to about 2.7 million people in the UK.

During the past two decades, deep brain stimulation (DBS) has been used to
treat tens of thousands of patients with Parkinson’s disease and epilepsy.
However, several trials for depression have ended in disappointment. A
major challenge is that the brain does not appear to have a single “depression
area”; several interconnected areas can be in play and these can differ
between people.

“We’re starting to recognise some of the complexity involved in how mood is

regulated in the brain as a network,” said Prof Edward Chang of the
University of California San Francisco, the neurosurgeon who treated Sarah.

A meticulous, personalised approach paved the way for the latest advance.
In an initial phase lasting a week, a temporary brain implant recorded a wide
range of activity while Sarah regularly logged her mood on a tablet. A
machine learning algorithm was used to identify a telltale pattern of activity
in the amygdala region accompanying Sarah’s lowest points.

Through trial and error the scientists identified a closely connected brain
area, the ventral striatum, where a tiny dose of electricity appeared to have
an immediate and profound impact.

“When I first received stimulation I felt the most intensely joyous sensation
and my depression was a distant nightmare for a moment,” said Sarah. “I just
laughed out loud. It’s the first time I had spontaneously laughed or smiled …
in five years.”

In a second round of minimally invasive surgery, a permanent device was

implanted, with a tiny battery unit embedded in her skull, to detect the
“depression signature” activity in the amygdala and automatically deliver
stimulation to the ventral striatum.

This happens about 300 times each day, equivalent to about 30 minutes of
stimulation. The electrical pulse is not accompanied by any sensation, Sarah

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Woman successfully treated for depression with electrical brain implant | Depression | The Guardian 05/10/2021 14(37

said, aside from a subtle feeling of alertness and positivity.

“The idea that we can treat symptoms in the moment, as they arise, is a
whole new way of addressing the most difficult-to-treat cases of depression,”
said Scangos. She hopes the work will also help dissolve the stigma that
“comes from the black box nature” of depression.

Sarah described a life before the treatment in which she barely moved, no
longer had opinions and “only noticed what was ugly in the world”. After
five years of suffering, she had run out of treatment options. The profound
effect of the implant confirmed to her that her depression was rooted in brain
biology and “not a moral failing, but a disorder that could be treated”.

The device costs about $35,000 (£26,000) and is an adapted version of one
normally used to treat epilepsy, called the NeuroPace RNS System. The UCSF
team has already enrolled two more patients and hopes to recruit a further
nine to assess whether the technique can be more widely applied.

Prof Eileen Joyce, a professor of neuropsychiatry at University College

London, who is leading a trial using deep brain stimulation for OCD, said:
“The results are genuine and significant. It’s a remarkable piece of
translational clinical neuroscience. I’m not sure that anyone else in the world
is doing that at the moment but I’m sure they will in future.”

McShane said that while the method would not be widely or immediately
applied, “if I was a medical student thinking about which field will show
exciting developments during my working life, I would be clocking this as a
reason to be considering psychiatry”. The findings are published in the
journal Nature Medicine.

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