Emily Hollenbeck suffered from a severe, recurring depression that she compared to a black hole, where gravity felt so strong and her limbs so heavy that she could barely move. She was aware that the illness had the potential to be fatal. Her parents had both taken their own lives.She was willing to try something risky: having electrodes implanted in her brain as part of an experimental therapy. Here’s all about deep brain stimulation.
What is deep brain stimulation?
According to researchers, the treatment, known as deep brain stimulation, or DBS, could eventually help many of the nearly 3 million Americans who suffer from depression that does not respond to other medications. It is approved for Parkinson’s disease and epilepsy, and many doctors and patients hope it will become more widely available for depression shortly.
The treatment provides patients with targeted electrical impulses, similar to a pacemaker for the brain. A growing body of recent research is promising, with more being conducted — though two large studies that found no benefit to using DBS for depression temporarily halted progress, and some scientists continue to express concerns.
Meanwhile, the FDA has agreed to expedite the review of Abbott Laboratories’ request to use its DBS devices for treatment-resistant depression.
“At first I was blown away because the concept of it seems so intense. Like, it’s brain surgery. You have wires embedded in your brain,” said Hollenbeck, who is part of ongoing research at Mount Sinai West. “But I also felt like at that point I tried everything, and I was desperate for an answer.”
Growing up in poverty and experiencing occasional homelessness, Hollenbeck developed depression symptoms. However, her first major bout occurred in college, following her father’s suicide in 2009. Another setback occurred during a Teach for America stint, leaving her almost immobile and concerned about losing her classroom job and falling back into poverty. She landed in the hospital.
“I ended up having sort of an on-and-off pattern,” she said. After responding to medication for a while, she’d relapse.
She earned a doctorate in psychology despite losing her mother in her final year of graduate school. However, the black hole always returned to pull her in. She admitted that she had considered suicide at times.
She claimed she had exhausted all options, including electroconvulsive therapy, when a doctor told her about DBS three years ago.
“Nothing else was working,” she explained.
She was one of only a few hundred people treated with DBS for depression.
Hollenbeck underwent brain surgery while sedated but awake. Dr. Brian Kopell, director of Mount Sinai’s Center for Neuromodulation, implanted thin metal electrodes in the subcallosal cingulate cortex, a region of her brain that regulates emotional behavior and is associated with sadness.
How does the pacemaker work?
An internal wire connects the electrodes to a device under the skin in her chest that regulates the amount of electrical stimulation and delivers constant low-voltage pulses. Hollenbeck calls it “continuous Prozac.”
Doctors say the stimulation is beneficial because electricity speaks the brain’s language. Neurons communicate via electrical and chemical signals.
Kopell explained that in normal brains, electrical activity reverberates unimpeded in all areas, like a dance. In depression, the dancers become stuck in the brain’s emotional circuitry. According to him, DBS “unsticks the circuit,” allowing the brain to function normally.
Hollenbeck reported that the effect was almost immediate.
“The first day after surgery, she started feeling a lifting of that negative mood, of the heaviness,” said her psychiatrist, Dr. Martijn Figee. “I remember her telling me that she was able to enjoy Vietnamese takeout for the first time in years and really taste the food. She started to decorate her home, which had been completely empty since she moved to New York.”
The most profound change for Hollenbeck was re-discovering his love of music.
“When I was depressed, I couldn’t listen to music. It sounded and felt like I was listening to radio static,” she said. “Then on a sunny day in the summer, I was walking down the street listening to a song. I just felt this buoyancy, this, ‘Oh, I want to walk more, I want to go and do things!’ And I realized I’m getting better.”
She only wishes that therapy had been available for her parents.
This treatment has been in development for more than two decades, beginning with promising early research led by neurologist Dr. Helen Mayberg.
The research found that DBS provided stable, long-term relief to depression patients over years
However, setbacks followed. Large studies conducted over a dozen years ago found no significant difference in response rates between treated and untreated groups. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, who also studies DBS and depression, cited a couple of reasons: The treatment was not personalized, and the researchers looked at the results over a period of weeks.
Later research found that DBS provided stable, long-term relief to depression patients over years. Overall, across different brain targets, DBS for depression has an average response rate of 60%, according to one 2022 study.
Treatments being tested by various teams are now much more tailored to individual needs. Mount Sinai’s team is one of the most well-known researchers of DBS for depression in the United States. A neuroimaging expert uses brain images to determine the exact location for Kopell to place electrodes.
“We have a template, a blueprint of exactly where we’re going to go,” said Mayberg, a pioneer in DBS research and founding director of The Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai. “Everybody’s brain is a little different, just like people’s eyes are a little further apart or a nose is a little bigger or smaller.”
Other research teams tailor treatment to patients, but their methods differ slightly. Scangos and her colleagues are researching various brain targets and providing stimulation only when necessary for severe symptoms. She stated that the most effective therapy may involve a combination of approaches.
As teams continue to work, Abbott plans to launch a large clinical trial this year, ahead of a potential FDA decision.
“The field is advancing quite quickly,” Scangos said. “I’m hoping we will have approval within a short time.”
However, some doctors are skeptical, citing possible complications such as bleeding, stroke, or infection following surgery.