Neurological

Treating Major Depression With On Demand Brain Stimulation

Doctors at UCSF Health successfully treated a patient with major depression by tapping into the specific brain circuit involved in depressive brain patterns and resetting it with the brain equivalent of a pacemaker.

The study, which appears in the October 4, 2021 issue of Nature Medicine, marks a breakthrough in years of efforts to apply advances in neuroscience to the treatment of psychiatric disorders.

This study points the way to a new paradigm that is badly needed in psychiatry. We have developed a precision medicine approach that successfully treats our patient’s treatment-resistant depression by identifying and modulating the circuitry in her brain that is clearly linked to her symptoms.

Andrew Krystal, PhD, Professor of Psychiatry and a member of the UCSF Weill Institute for Neurosciences.

The path to this project at UC San Francisco began with a large, multi-center initiative that was funded by President Obama in 2014 as part of the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) initiative.

As part of this initiative, UCSF neurosurgeon Edward Chang, MD, and colleagues conducted studies to understand depression and anxiety in patients undergoing surgical treatment for epilepsy, which are also common with mood disorders. The research team discovered patterns of electrical brain activity that correlated with mood states and identified new areas of the brain that could be stimulated to alleviate depressive moods.

Using the results of previous research as a guide, Chang, Krystal, and first author Katherine Scangos, MD, PhD, all members of the Weill Institute, developed a strategy that relies on two steps that have never been used in psychiatric research: the depression cycle and Characterization of your neural biomarker.

This new study summarizes almost all of the critical findings from our previous research into a complete treatment aimed at relieving depression.

, Edward Chang, who is co-senior author with Krystal and is the Joan and Sanford Weill Chair of Neurological Surgery.

The team evaluated the new approach under an FDA test device exemption in June 2020 when Chang implanted a responsive neurostimulation device that he has successfully used in the treatment of epilepsy.

We were able to offer this bespoke treatment to a depressed patient and she was relieving her symptoms. We have not yet succeeded in providing such a personalized therapy in psychiatry.

Katherine Scangos

While the approach looks promising, the team cautions that this is only the first patient in the first study.

Its a lot to do. We need to look at how these circuits differ in patients and repeat this work several times. And we need to see if a person’s biomarker or brain circuit changes over time over the course of treatment.

Katherine Scangos, who added two more patients to the study and hopes to add nine more. “

FDA approval for this treatment is still a long way off, but the study suggests new ways to treat major depression. Krystal said that understanding the brain circuits underlying depression will likely lay the foundation for future non-invasive treatments that can modulate those circuits.

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