Roughly 20 million people suffer from depression in the united states. for about 10 percent of them, nothing in psychiatry’s standard arsenal offers relief, not the extensive repertoire of drugs, not cognitive therapy, not even electroconvulsive treatments (what used to be called shock therapy). Their disease is life-threatening, with a high risk of suicide. Emory University neurologist Helen Mayberg has pioneered a startling way to help people suffering from this devastating form of depression, by literally getting inside their heads. The treatment, known as deep brain stimulation (DBS), involves drilling into a patient’s skull and inserting very thin wires that deliver current to precisely targeted brain regions.
Deep brain stimulation is still experimental; it has been deployed in fewer than a hundred severely depressed patients. But in some cases, it has resulted in an almost instantaneous transformation. Mayberg, professor of psychiatry and neurology and Dorothy C. Fuqua Chair in Psychiatric Neuroimaging and Therapeutics, has seen patients, weighed down for years by hopelessness, emerge into the world just moments after a small electric current is applied to their brain. The success of DBS suggests a new, more biologically precise definition of depression based on brain circuits, physically interconnected neurons that signal each other and form anatomical networks. Think of it this way: The brain is like a circuit board, and mood disorders are glitches in its wiring, or disruptions in how signals travel from one node to another. A disordered brain may need tweaks in order to break out of a loop of despair. Mayberg explored the repercussions of this new view—what she calls Depression 3.0—with discover reporter Sherry Baker.
Antidepressants and cognitive therapy help many people suffering from depression. Why take such a drastic surgical approach?
M: Most people are familiar with forms of depression where people are functional, trying to get through their lives, but needing some help from therapy or drugs or both. I initially had that view of the disease. But then I saw people disabled by treatment-resistant depression. They had no options after multiple medications, psychotherapy, and electroconvulsive therapy had failed. They suffer enormously. They may kill themselves. Severe depression robs these people of their past. They can’t even remember what it was like to be well. The disease hijacks their memory and colors everything. Sure, surgery might seem radical to psychiatrists who want to try yet another mix of drugs, even though nothing has worked before. And I’ve had ethicists ask, “How could you use invasive surgery on the depressed?” But they’ve clearly never met a patient in this tragic situation.
How did the new techniques of brain imaging get you interested in depression?
