The Deep Brain Stimulation surgery in India has shown successful results in a majority of patients suffering from advanced stages of the Parkinson’s disease and is now a well-accepted treatment. While this surgery showed major improvements in Parkinson’s disease patients for controlling motor movements and the like, until recent time there was no substantial evidence that the same surgery could be used for patients suffering from depression. However, thanks to medical research on the matter, it has been proved that DBS can be a viable option for treatment resistant depression in patients, especially for unipolar major depressive disorder (MDD) or bipolar II disorder (BP). And DBS for depression is now being talked about extensively.
Depression is a serious and incapacitating medical illness. While MDD is prone to being resistant to allopathic treatment and slowly immune to medication, bipolar II disorder patients are known to go into a hypo-manic or manic episode state when given antidepressant medications. These aspects make DBS an ideal solution for such patients. Deep Brain Stimulation uses high frequency electrical stimulation to target a specific area of the brain for a particular neuro-psychiatric disorder. While DBS has shown substantial improvement in many patients that undergo depression surgery for general depression, most studies on the matter have shown mixed results.
Patient selection is crucial to the success of depression surgery. It is important that the patient be offered surgical evaluation at an appropriate centre which has the expertise of evaluating such patients. At Jaslok hospital, such patients are evaluated by two psychiatrists and a neurosurgeon. They establish if the disease is indeed incurable with medical treatment and the patient has been offered adequate trial of best medical therapies. If they find it appropriate, he is referred to a committee to confirm the findings and only after such stringent evaluation surgery is offered. Remember that even though this depression surgery may help and show marked improvement in the patient, it may be recommended that the medication and other treatments like counselling, psychotherapy, rehabilitation, etc., be continued even after the depression surgery. There can be cases where DBS may not be the best option at hand, with such patients the conventional psychiatric or psychologist help with allopathic medication may be the only way for now, until there is another scientific breakthrough that can benefit them.
In view of the fact that depression surgery is a ray of hope for many, but still not the right treatment for every person caught in the anguish of this disorder, it is important to continue the research and clinical trials on the subject. Many hope that a close understanding of DBS and how it works on the brain can provide researchers with the insight they need to find a cure for depression and other psychopathic diseases.
The surgery was done under local anesthesia with stereotactic guidance keeping the patient completely awake during the procedure. Initially, a frame is applied to the patients head and CT scan was done. These images are fused with the previous MRI images of brain using a special software program and the specific target in the brain i.e., subgenual cingulate gyrus area 25 is visualized. Dr. Doshi does the optimum target and trajectory planning for DBS. After that, the patient is brought to the operation theatre. During surgery, Benjamin was tested by asking several questions relating to his mood and feelings. As the lead was inserted and the brain stimulated, Benjamin said he was feeling lighter than before, smiled during the procedure, felt relieved of stress and felt like talking to his old friend to whom he stopped talking for a long time, indicating improvement in feelings. The leads were connected to a pacemaker that delivers continuous stimulation to the brain. As days progress, the effect of stimulation builds up and we look forward to a greater improvement in his mood.
Biochemical disturbances in certain brain chemicals called neurotransmitters are thought to be the underlying cause of depressive disorders in general. Major depression is a major psychiatric disorder in which, the prominent symptom is a disturbance of mood which is a constant feeling that is experienced internally and that influences a person’s attitudes, thinking, behaviour and perception. The prevalence of Major Depression is about 2%-6%, more commonly in women.
Dr. Paresh Doshi, Director of the functional neurosurgical department at Jaslok Hospital, established this program in 1998 to treat movement disorders, epilepsy, spasticity, pain and psychiatric disorders. The first Deep brain stimulation (DBS) surgery in India was performed here. Dr. Doshi has performed over 250 DBS surgeries at Jaslok Hospital, which is the largest in India and is credited as the only Indian on the task force for “guidelines for psychiatric disorders surgery”.
Dr. Amit Desai, has been a Consultant Psychiatrist at Jaslok Hospital for almost 13 years. He specialises in adult psychiatry. Psychiatric consultant on Jaslok Hospital’s Functional Neurosurgical Department panel for DBS related to Parkinson’s Disease and Obsessive Compulsive Disease.
Presentation available on slide share: http://www.slideshare.net/pareshkd/dbs-for-depression