Is deep brain stimulation a good treatment for depression?

Even though there has been a lot of hype about DBS, the procedure has not yet been approved by the FDA for treatment of depression. The technique remains experimental and is only available for those who want to participate in clinical trials.

To date only a few patients with depression have been studied and the results are somewhat promising.  Data from the few patients who underwent DBS indicated that not all patients derived the same benefit and no one was cured of depression. Researchers are still trying to identify the best location for placement of electrodes to help reduce symptoms and have fewer side effects.

While all this sounds great, one should understand that DBS is a surgical procedure and does carry great risks. Some of the complications of surgery are more unpleasant than the depression itself.  These include a stroke, bleeding, seizures, sudden jolts, infection, speech impairment, breathing difficulties, abnormal body movements and hearing problems. In addition, the pacemaker or the electrode may get infected and this means removal of all the hardware- which means another surgery.

The batteries used for the pacemaker only last a few months and need constant replacement. The battery replacement requires a surgical procedure and anesthesia. Like any mechanical device, the electrodes may break, kink, disconnect or may discharge inappropriately.

The surgery involves drilling two small holes in the skull and electrodes are guided into the brain using some type of imaging technique. The electrodes are then tunneled underneath the skin and connected to the pacemaker, which is embedded in the upper chest. After surgery, the pacemaker is evaluated and the amount of electrical stimulus you need is adjusted according to your moods and side effects. The pacemaker is automatically programmed using a magnetic device and stimulation is continuous.

Just because you undergo DBS does not mean you will be off your anti depressant medications.  The long-term results are unknown and while the dose of your anti depressant medication may be lowered, you definitely will not be stopping the medications anytime soon.

Therefore, before you jump into the cue for DBS, discuss the issue with your doctor and ask to speak to people who have had this procedure.  Doctors always like to glorify any new procedure but what they do not always tell you is all the bad things that can happen. While anti depressants do have many side effects, they are a much safer alternative than any type of brain surgery. So far, DBS is only reserved for individuals whose depression is severe and not controlled by any medication.