Major depressive disorder (MDD) is a serious mental illness impacting millions of adults in the U.S. Symptoms of MDD, such as feeling worthless, hopeless, and suicidal, are often severe enough to prevent a person from working, going to school or taking care of family responsibilities. The National Institutes of Health (NIH) report that more adults between the ages of 18 and 25 are diagnosed with MDD than any other age group. Moreover, nearly 20 percent of adults report experiencing at least one MDD episode every year.
Treatment for MDD typically involves cognitive behavioral therapy, counseling and medications known as “selective serotonin reputake inhibitors” (SSRIs). Individuals with depression, whether mild or severe, present with low levels of serotonin. A neurotransmitter released in the brain, serotonin regulates mood, sleep, appetite, and motivation. Medications like SSRIs prevent receptors on neurons from “reuptaking” serotonin so that more serotonin is available in the brain. Raising low levels of serotonin works to stabilize mood and support signaling among neurons in the brain.
In addition to understanding how serotonin and other neurotransmitters affect mood and emotion, neuroscientists are now investigating brain circuit dysfunction that may contribute to the development of mental illness. Neurons acting as the brain’s messaging system not only rely on normal neurotransmitter levels to work properly, but also require electrical impulses to transmit information.
These electrical impulses depend on axons to move back and forth among the billions of neurons in the brain. Long and incredibly thin, axons are tube-like structures covered in myelin, a fatty substance essential for transmitting electrical signals (action potentials) throughout the brain.
Today, neuroimaging technology is revealing new insights into the causes of mental illness and treatment-resistant depression. One of those insights involves electrical signaling among neurons. Researchers haven’t pinpointed the exact mechanism behind on-demand brain stimulation for depression relief, but the evidence is accumulating that it can be successful.
What is On-Demand Brain Stimulation?
Electrically stimulating certain areas of the brain to treat mental illness is not new. Electroconvulsive therapy (“electroshock therapy”) was introduced in 1938 to treat mental illness. Although ECT is FDA-approved today for treating MDD, bipolar disorder, and catatonia, it does not target specific areas of the brain like on-demand brain stimulation does.
Neuroscientists have recently discovered the existence of neural biomarkers that reveal certain electrical patterns underlying general brain activity. These neural biomarkers appear to be unique to each individual with a mental illness. Strikingly, when a person’s neural biomarker patterns develop a different set of patterns, that may indicate the onset of a mental illness, some scientists believe.
By customizing an on-demand brain stimulation device that reacts when an individual’s patterns change, doctors at UC San Francisco (UCSF) were able to significantly reduce symptoms of treatment-resistant major depressive disorder. When the device was activated, it stimulated a neural biomarker area to modify the pattern. This type of on-demand treatment successfully “reset” the patient’s brain patterns that were associated with severe depression. The UCSF researchers stated that this device works like a heart pacemaker does to stabilize heart rhythms and causes no side effects.
Although FDA approval for this on-demand brain stimulation device is still years away, scientists are optimistic about the results of these early trials. Neuroscientists think that the more we understand how brain circuitry contributes to major depressive disorder, the more likely it is that noninvasive methods for regulating neural biomarker patterns will be developed. Currently, the on-demand brain stimulation device requires minimally invasive implantation surgery.
On-Demand Brain Stimulation Vs. Deep Brain Stimulation
On-demand brain stimulation is not the same as deep brain stimulation (DBS). DBS is approved by the FDA for treating movement disorders such as Parkinson’s disease, epilepsy seizures that do not respond to medications, and dystonia. It may also be used to reduce symptoms of severe obsessive-compulsive disorder involving repetitive behaviors.
People treated with DBS have electrodes implanted in a specific area of their brain. Electrical impulses emitted by these electrodes are meant to regulate abnormal patterns and/or stabilize levels of dopamine and other neurotransmitters implicated in movement disorders. A pacemaker-like device that is surgically placed under the patient’s skin in their upper chest controls when electrical impulses are sent to the brain.
Although DBS has been used to treat major depressive disorder, the results have been inconsistent and not wholly successful. The reason for this involves the “open-loop” approach that DBS takes to stimulating the brain versus the “closed-loop” approach that on-demand brain stimulation takes.
The open-loop approach used by DBS delivers a constant, fixed electrical impulse to just one area or structure in the brain. For example, people with severe epilepsy may have impulses targeting the left or right side of the brain, depending on which part of their body is affected by seizures. Neural biomarkers are not targeted with an open-loop approach because they are not implicated in movement disorders. However, individuals with treatment-resistant MDD are now known to have different neural biomarkers underlying different clusters of MDD symptoms.
On-demand brain stimulation delivers closed-loop stimulation that responds immediately to frequent pattern changes. The discovery of neural biomarkers in individuals with MDD is the primary reason for the recent clinical success of on-demand brain stimulation.
There is Hope for Depression
When used in combination with antidepressant medication, cognitive-behavioral therapy (CBT) can help people with MDD understand and manage feelings of sadness, hopelessness, and guilt. Individuals who are depressed have often become trapped in a cycle of low self-esteem and feelings of worthlessness caused by fixed patterns of negative thinking. One reason depression occurs is because of the way a person perceives or places distorted meanings on things, events, and other people’s actions. CBT teaches you to recognize and stop negative thoughts by viewing reality through a more objective, rational lens.
When depression is disrupting work, family, and/or social life, consulting a trusted provider like FHE Health can help. Relying on self-help books or unsubstantiated treatments won’t make depression just “go away.” Feeling depressed all the time is not a choice nor is it your fault. Depression emerges from a combination of factors that require professional, empathetic help from psychiatrists and therapists experienced in treating depression.
FHE offers compassionate, therapeutic programs for individuals needing help with managing depression symptoms. Our goal is to provide effective depression treatment tailored to address each client’s unique needs, so they can resume normal day-to-day activities and maintain a meaningful, high-quality level of life. Contact us today if you or a loved one is suffering from depression.