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Brain surgery for depression? Yes, maybe. Deep brain stimulation, in which electrodes are implanted in the brain, may help people with treatment-resistant depression where all other therapies failed to deliver.

Antidepressants and talk therapy — that's how depression is treated, right? Not brain surgery? Actually, you'd be surprised. 

What is deep brain stimulation?

Deep brain stimulation (DBS) is fascinating, actually. It's a procedure in which electrodes are embedded in particular areas of the brain — depending on the condition the person is suffering from — to send electric impulses that are meant to regulate "faulty" impulses going on in the brain without DBS. These electrodes in the brain are connected to a device implanted in the upper chest. Then, there's an external controller, essentially a remote control, that can determine the strength of the impulses as well as switching the device on and off. 

Deep brain stimulation, which would once have sounded like something out of some sci-fi novel, is now becoming more and more popular for conditions like epilepsy and movement disorders such as Parkinson's disease. It doesn't always lead to a significant improvement in symptoms, but when it does, DBS can have a drastic positive impact on a patient's quality of life. 

So, deep brain stimulation is used for the treatment of depression? 

Yes, sometimes. 

Psychotherapy and antidepressants remain the first-choice treatments for patients who initially present with clinical depression. If those do not lead to symptom improvement at all, the second choice would be to try different kinds of antidepressants and talk therapy. Where that is not successful either, and a person continues to suffer from major depressive disorder after a significant period of time has passed, that's called treatment-resistant depression. Your doctor won't immediately skip to deep brain stimulation; electroconvulsive therapy is also being used again, sometimes with very good results. 

When all other options have failed and you remain depressed, however, deep brain stimulation just may be on the table.

The electrodes can be implanted in various areas of the brain in cases where it is used to treat depression. We won't get too technical, but it is important for the medical team to consider the "target" — where the electrodes end up, very carefully. 

Research has revealed that deep brain stimulation is really quite promising for people with treatment-resistant depression. Studies, including randomized controlled trials, shows that DBS really does tend to lead to a very significant reduction in depressive symptoms. Because further study is still needed, however, DBS for depression remains an experimental treatment at the moment. This is for good reason — research has also found that significant portions of those who receive DBS for depression do experience side effects, though it's not currently clear if they are directly caused by deep brain stimulation. 

What are the potential side effects and risks of deep brain stimulation?

A lot of data is available from people who have received deep brain stimulation for epilepsy and movement disorders. It has shown that DBS is generally pretty safe, but since deep brain stimulation is a surgery, it can carry risks like any other operation. These can include:

  • Brain hemorrhage is thought to affect around two to three percent of patients who undergo DBS. Though this doesn't actually always cause problems, it can also lead to stroke, paralysis, speech difficulties, and other problems. 
  • As with any surgery, infection is a possibility. In some cases, an infection necessitates the removal of the DBS system.
  • In a small number of cases, the surgery will cause a leak of cerebrospinal fluid. This can cause meningitis

Side effects that some patients experience after deep brain stimulation, which are often temporary, include pain and swelling where incisions were made, tingling sensations in the face or extremities, an allergic reaction to the implant, speech difficulties, dizziness, and balance and coordination difficulties. 

Because the DBS system has multiple settings, it may take some time for doctors and patients to find the right one. 

Conclusion

Where deep brain stimulation works for treatment-resistant depression, some patients find that they experience revolutionary changes in their mood and wellbeing. For these patients, DBS can be a "God send", as it were — one that doesn't just cause temporary relief of some of the symptoms of depression, but makes their whole person feel better. 

The procedure does not always work, however, and there are risks. Having someone poke around in your brain to implant electrodes and stick a pacemaker-like device in your chest is a huge decision, more so because the treatment is still in its experimental stages for depressed patients. 

However, it is being used more often now, and with promising results. Is deep brain stimulation right for you? Certainly not if you have major depressive disorder that actually responds well to antidepressant therapy and psychotherapy, even if it is recurring. For people with treatment-resistant depression that simply hasn't gotten better no matter what treatment has been tried, deep brain stimulation may, on the other hand, succeed where everything else failed. In these cases, it can potentially finally give a person the quality of life they deserve. 

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