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Deep Brain Stimulation (DBS)

What is deep brain stimulation?

Key points

  1. DBS is a surgical procedure that involves implanting electrodes in the brain.
  2. It has been shown to be useful in the treatment of persistent depression.
  3. Doctors recommend that you try drugs and therapy before opting for DBS.

Deep brain stimulation (DBS) has been shown to be a viable option for some people who have depression. Doctors originally used it to help manage Parkinson’s disease. In DBS, a doctor implants tiny electrodes in the part of the brain that regulates mood. Some doctors have practiced DBS since the 1980s, but it’s a rare procedure. Although long-term success rates have yet to be established, some doctors recommend DBS as an alternative therapy for patients whose previous depression treatments have been unsuccessful.

How deep brain stimulation works

A doctor surgically implants tiny electrodes in the nucleus accumbens, which is the region of the brain responsible for:

  • dopamine and serotonin release
  • motivation
  • mood

The procedure requires multiple steps. First, the doctor places the electrodes. Then, a few days later they implant the wires and battery pack. The electrodes are connected via wires to a pacemaker-like device implanted in the chest that delivers pulses of electricity to the brain. The pulses, which are generally delivered constantly appear to block the firing of neurons and return the brain’s metabolism back to a state of equilibrium. The pacemaker can be programmed and controlled from outside the body by a handheld device.

Although doctors aren’t exactly sure why the pulses help the brain reset, the treatment appears to improve mood and give the person an overall sense of calm.

Purpose

In many DBS clinical trials, people have reported alleviation of their depression and a significant increase in quality of life. In addition to depression, doctors use DBS to treat people with:

  • obsessive-compulsive disorder
  • Parkinson's disease and dystonia
  • anxiety
  • epilepsy
  • high blood pressure

DBS is an option for people with chronic or treatment-resistant depression. Doctors recommend extended courses of psychotherapy and drug therapy before considering DBS because it involves an invasive surgical procedure and success rates vary. Age usually isn’t an issue, but doctors recommend that you be in good enough health to withstand a major surgery.

Possible complications

DBS is generally recognized to be a safe procedure. However, as with any type of brain surgery, complications can always arise. Common complications associated with DBS include:

  • a brain hemorrhage
  • a stroke
  • an infection
  • a headache
  • speech problems
  • sensory or motor control issues

Another factor to consider is the need for subsequent surgeries. The chest-implanted monitoring device can break, and its batteries last between six and 18 months. The implanted electrodes may also need to be adjusted if the treatment doesn’t appear to be working. You need to consider whether you’re healthy enough to undergo a second or third surgery.

What the experts say

Because long-term studies and clinical trials show varying results with DBS, doctors can only point to their own successes or failures with the procedure. Dr. Joseph J. Fins, chief of medical ethics at New York-Presbyterian Hospital/Weill Cornell Center, says that using DBS for mental and emotional conditions should be “adequately tested before it’s called a therapy.”

Other experts think DBS is a viable option for people who aren’t seeing success with other therapies. Dr. Ali R. Rezai of the Cleveland Clinic notes that DBS “holds promise for the treatment of intractable major depression.” 

The takeaway

DBS is an invasive surgical procedure that has varying results. Reviews and opinions are mixed in the medical field. The one thing most doctors agree on is that DBS should be a distant choice for treating depression and that people should explore medications and psychotherapy before opting for the procedure. Talk to your doctor if you think DBS might be an option for you.

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