Therapeutic Approach for Patients with Severe Depression

Photo: Man with depression

People with severe depression are
constantly despondent, lacking
in drive and no longer feel joy;

A new perspective is thus opened for people with the most severe depression who do not respond to any other therapy. People with severe depression are constantly despondent, lacking in drive, withdrawn and no longer feel joy. Most suffer from anxiety and the desire to take their own life. Approximately one out of every five people in Germany suffers from depression in the course of his/her life – sometimes resulting in suicide. People with depression are frequently treated with psychotherapy and medication. “However, many patients are not helped by any therapy,” says Professor Thomas E. Schläpfer from the Bonn University Medical Centre for Psychiatry and Psychotherapy. “Many spend more than ten years in bed – not because they are tired, but because they have no drive at all and they are unable to get up.”

One possible alternative is “deep brain stimulation,” in which electrodes are implanted in the patient’s brain. The target point is the nucleus accumbens - an area of the brain known as the gratification centre. There, a weak electrical current stimulates the nerve cells. Brain pacemakers of this type are often used today by neurosurgeons and neurologists to treat ongoing muscle tremors in Parkinson’s disease.

In 2009, the Bonn scientists were able to establish that brain pacemakers also demonstrate an effect in the most severely depressed patients. Ten subjects who underwent implantation of electrodes in the nucleus accumbens all experienced relief of symptoms. Half of the subjects had a particularly noticeable response to the stimulation by the electrodes.

“In the current study, we investigated whether these effects last over the long term or whether the effects of the deep brain stimulation gradually weaken in patients,” says Schläpfer. There are always relapses in the case of psychotherapy or drug treatment. Many patients had already undergone up to 60 treatments with psychotherapy, medications and electroconvulsive therapy, to no avail. “By contrast, in the case of deep brain stimulation, the clinical improvement continues steadily for many years.” The scientists observed a total of eleven patients over a period of two to five years. “Those who initially responded to the deep brain stimulation are still responding to it even today,” he says. During the study, one patient committed suicide. “That is very unfortunate,” says Schläpfer. “However, this cannot always be prevented in the case of patients with very severe depression.”; Source: Bonn University