Deep Brain Stimulation Shows Promise in Treating Depression

A cutting-edge surgery may alleviate debilitating symptoms.

For 17 years, Vito Randazzo suffered from chronic depression and debilitating suicidal thoughts that kept him from working as a contractor in his dad’s business, and led him to withdraw from his wife and children.

He says he tried every conceivable medication and treatment — from antidepressant medications and behavioral therapy to 60 rounds of electroconvulsive therapy and ketamine infusions, a treatment that provides short-term relief by putting the patient into a semiconscious state.

Nothing helped.

“As a family we were in survival mode,” says Vito, a Long Island native. “Doctors were telling us there were no treatments left to try.”

That was until two years ago, when he heard about deep brain stimulation (DBS), a procedure that uses electrical currents to correct abnormal brain signals caused by certain diseases and disorders. At NewYork-Presbyterian/Columbia University Irving Medical Center, neurosurgeon Dr. Sameer Sheth had been regularly using DBS to treat patients with Parkinson’s disease. He was interested in applying DBS for the treatment of other chronic neuropathic and psychiatric ailments, like depression.

Although the Food and Drug Administration approved the procedure for essential tremor in 1997 and Parkinson’s disease in 2002, it remains under investigation for depression. But Vito was willing to try anything.

Dr. Sameer Sheth

“At this point, I had no life,” he says. “I was apprehensive that DBS was going to work, but the thought never crossed my mind not to try it.”

Vito connected with Dr. Sheth in 2015 and became his first patient to undergo DBS surgery for depression in 2016. “When you’re at the end of your rope, it’s a real challenge to be patient,” says Vito. “There were multiple MRIs, and meetings and testing with various doctors in order to determine whether I was a candidate.”

The procedure consists of inserting two thin electrodes into a specific target inside the brain. The electrodes run under the skin and down the side of the neck. They are connected to a pacemaker-like battery that is placed under the skin in the upper chest. The target for the electrodes within the brain depends on the disorder being treated. For example, they would go in movement-related circuits for movement disorders like Parkinson’s disease, and in mood-related circuits for mood disorders like depression.

“Moreover,” says Dr. Sheth, “even for two patients with depression, the target would still be individualized based on that patient’s anatomy.”

The system runs on battery power, using an external device held up to the skin, which sends continuous stimulation to the brain. This therapy seeks to dampen the abnormal rhythms associated with the disorder, thereby restoring the natural rhythms within the affected brain circuits.

The extent of the relief varies by individual.

“Rarely is it a complete cure,” says Dr. Sheth. “Patients typically still have to work hard to fight through the depression, but this may enable them to do it successfully for the first time.”

DBS is also showing some promise as a potential treatment for other conditions. A February 2017 study published in the The Lancet Psychiatry medical journal suggests that DBS might help improve mood and anxiety and promote weight gain in those who have anorexia. Meanwhile, Dr. Sheth is also working to solve the puzzle of schizophrenia from this angle and is part of a group of NewYork-Presbyterian neurologists and psychiatrists who are developing a DBS program for obsessive-compulsive disorder, Tourette’s syndrome, autism, and other disorders.

“Patients typically still have to work hard to fight the depression, but this may enable them to do it successfully for the first time.”

— Dr. Sameer Sheth

Vito vividly remembers parts of his 12-hour DBS surgery since he was kept awake for about two hours of it.

“The whole time Dr. Sheth and the other surgeons were implanting this device in my head, they wanted to know how I would react,” he recalls. “They would turn it off and on and ask me if anything had changed.” After 17 years of chronic pain, Vito felt a significant difference in two depression symptoms, headaches, and chest heaviness.

“I’ve always had a headache, and one time when they turned it on, all of a sudden my headache was relieved,” he says. “Another time, I was able to breathe easier.”

He also noticed that colors became more vivid and that his sensitivity to light increased. “Things just appeared much brighter,” he says.

Though Vito experienced immediate effects during the surgery, Dr. Sheth cautioned that it might take him several months to notice a marked effect. After seven months, others around him started noticing subtle improvements even before Vito did.

“My husband was suicidal before the surgery and I worried that something might happen to him,” says Vito’s wife, Kathy. “But, after the surgery, I noticed that when I came home from work, he might be cooking dinner and whistling. As silly as that sounds, it showed me his mood had lifted.

“It’s an overwhelming sense of relief to be able to leave the house and not have the constant worry and stress that something bad was going to happen,” she says.

Adds Vito, “I think because DBS has alleviated my depression, it has alleviated the symptoms that go along with it.”

Vito Randazzo and his wife, Kathy

Dr. Sheth measures the treatment’s success by collecting information about the severity of symptoms. “We measure response using standard depression symptom scales, like the Hamilton Depression Scale,” says Dr. Sheth, of the questionnaire to gauge the severity of one’s depression. “For Vito, his score has come down significantly — by more than half — after DBS, which classifies him as a ‘full responder.’ That doesn’t mean that he’s symptom-free, but rather that he’s much better, and can at least function closer and closer to how he was before his depression set in.”

Today, the electrodes in Vito’s brain are always on. The battery will last about three to four years. Dr. Sheth can eventually perform a 30-minute outpatient surgery to replace the device in Vito’s chest without touching the electrodes in the brain. The device stays in indefinitely, as long as the therapy is beneficial. It’s not a magic bullet, and Vito still struggles, but it is an aid that has helped him get on the right track.

“I have to force myself every single day to do something,” he says. “I might force myself to do something for a half-hour, but [now] I find I can do it for 45 minutes, an hour, or longer.”

Looking ahead, Vito hopes to return to the workforce.

“I am catching up on all of the projects I had around the house, including finishing our basement,” he says. “My goal is to ease back into some type of work within the next six months, even if it’s part time.”

“Depression is debilitating not only mentally but physically as well,” Vito says. “Before, I couldn’t do simple things like mow the lawn, or just leaving the house some days was an overwhelming task.

“Now I’m able to do everyday activities that most people take for granted. And I’m trying to make up for lost time with my daughters. I feel like I’ve missed out on so much of their lives, and this is giving me an opportunity to reconnect with them.”

“Despite Vito’s illness, we’ve had a good life, but at times, it’s been an uphill battle to say the least,” says Kathy. “I feel like we have a new lease on life, and we’re doing things as a couple and a family that we were never truly able to enjoy before.”

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