Mit zwei Elektroden stimulierten die Freiburger Ärzte bei schwerstdepressiven Patienten das mediale Vorderhirnbündel (blau), das an der Wahrnehmung von Freude und Belohnung beteiligt ist. © Universitätsklinikum Freiburg
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A joint study carried out by the University Clinic Freiburg and the University Clinic Bonn has now shown: severe depression can be significantly alleviated by deep brain stimulation. 16 volunteers took part in the largest study of its kind in the world. Their symptoms improved considerably after only a short time.

“The study is unique worldwide in terms of the number of patients and the effect achieved. For the first time, we were able to show in a large study that deep brain stimulation is a serious option for patients with severe depression.”

…, said Prof. Dr. Thomas Schläpfer, head of the Department of Interventional Biological Psychiatry at the Department of Psychiatry and Psychotherapy at the University Clinic Freiburg.

In the patients, a part of the reward system in the brain was stimulated by means of wafer-thin electrodes, which resulted in a clear improvement of the complaints in all patients. On average, the severity of depression was halved. Half of the test persons were even below the level at which depression generally needs to be treated. In addition, most patients already reacted to the stimulation in the first week. The scientists are particularly pleased that the positive effects continued during the one-year study. According to the study, people with severe, treatment-resistant depression can benefit not only acutely, but also long-term from deep brain stimulation.

Alternative Therapy Option

It is estimated that ten to 30 percent of all people with recurrent depression do not respond to approved therapies. For some of these people, deep brain stimulation may be a therapy option. The 16 participants in the FORSEE II study had suffered for between 8 and 22 years from severe depression. On average, they had unsuccessfully undergone 18 drug therapies, 20 electroconvulsive therapies, and 70 hours of psychotherapy.

Prof. Dr. Volker A. Coenen, first author of the study and head of the Department of Stereotactic and Functional Neurosurgery at the Department of Neurosurgery at the University Clinic Freiburg, and his team implanted the wafer-thin electrodes into the patients. They stimulated the medial forebrain bundles. This area of the brain is involved in the regulation of the perception of joy and reward and is therefore also important for motivation and quality of life.

Clear Relief After a Short Time

On a monthly basis, the doctors evaluated the effect of the therapy with the help of the established Montgomery-Asberg Depression Rating Scale (MADRS). Already in the first week, the MADRS value dropped significantly in ten subjects and remained at a low level. In the course of the study, all subjects responded to the stimulation. Eight of the 16 patients had a MADRS value of less than 10 points at the end of the study. With this result, they were not considered depressed.

“Our patients have struggled with severe depression for years and nothing has improved. The deep brain stimulation led to a significant relief in most people within days, which then lasted continuously”,

Prof. Schläpfer is pleased and adds: “Other forms of therapy such as medication or psychotherapy often lose their effectiveness over time. The absolutely sensational thing about the data is that the effect of the therapy seems to be lasting, the positive effects last for years”. The scientists had already found out in a pilot study that the stimulation of the medial forebrain bundle is very promising. Now they are happy to see the same clear effects again.

Hope for European Approval of the Procedure

Based on the results of the recently published study, the Freiburg researchers started their third study (FORESEE-III) in October 2018. This study will treat 50 severely depressed patients. 15 patients have already undergone surgery. “If the follow-up study is as successful as the current one, there is great hope that the procedure will be approved in Europe”, said Prof. Schläpfer. The study was published online on Thursday, March 14, 2019 in the Nature specialist magazine Neuropsychopharmacology.


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