An Impulse of Hope for Individuals with Treatment-Resistant Depression

By Erik Schiferle

As midterm season at Columbia is nearing an end, surely some students are suffering from the blues. Short periods of the blues are not out of the ordinary, especially for people in high stress environments. However, if an individual lacks a sense of well-being for extended periods of time or with an intensity great enough to create a loss of interest in daily activity, the individual may be suffering from a mood disorder.

According to the National Institute of Mental Health, approximately 11 percent of adolescents suffer from a depressive disorder by age 18 and approximately 9.5 percent of the U.S. population age 18 or older in a given year has a mood disorder. For many, psychological counseling and the use of psychiatric medication ease mood disorder symptoms. However, for some, standard treatments are not enough. Individuals that do not respond to standard treatments may have treatment-resistant depression or refractory depression. Unfortunately, there are no proven treatment options for individuals with treatment-resistant depression.

However, in a preliminary study of treatment-resistant depression, Helen S. Mayberg of Emory University and her colleagues observed that an area of the brain known as Brodmann area 25, or the subgenual cingulate, is extremely rich in serotonin transporters. The researchers also observed that Brodmann area 25 is metabolically overactive in individuals with treatment-resistant depression. They believed that the elevated levels of activity could be linked to the inability to treat the resistant form of depression. Using an experimental procedure known as Deep Brain Stimulation Surgery, the researchers performed a study in an attempt to reduce the elevated brain activity.

Deep Brain Stimulation Surgery involves implanting two metal electrodes into white matter tissue of the brain adjacent to Broadmann area 25, denoted “Cg25” in the photo. The electrodes are attached to an external power source that provides a high frequency impulse of electricity. The electrodes remain in the brain for an indefinite period of time to provide continuous stimulation. The six subjects upon whom the stimulation surgery was performed remained conscious during the procedure so that Mayberg and her colleagues could observe their mood changes. According to Mayberg in a publication released in 2005, “all patients reported acute effects including ‘sudden calmness or lightness,’ ‘disappearance of the void,’ a sense of heightened awareness, increased interest, ‘connectedness,’ and sudden brightening of the room.”

Mayberg and her colleagues concluded that continual stimulation of Broadmann area 25 resulted in remission of depression in four of the six patients. She reported that the electrical stimulation of the “subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.” However, A.L. Malizia of North Bristol NHS Trust and his colleagues reported earlier this year that Deep Brain Stimulation may not result in lasting benefits for patients with treatment-resistant depression. In their study of eight patients, only two patients achieved response/partial response, three patients had a temporary response, while the remaining three patients had no response. Malizia stated that a significantly larger group should be studied to confirm or refute his findings.

There is still much work to be done to develop treatments for people with treatment-resistant depression. However, in many cases, depression is treatable. Each year, depression claims the lives of many people that could have had successful treatment. Many of these deaths are preventable, but they continue to occur because of the stigmas associated with seeking help to battle the disease. Not only must great strides be made to develop alternative treatments for the disease, but also in the ability to convince people that there is nothing wrong with seeking help.