Experiment in the United States on a woman who now claims to feel good. But there are many doubts and the idea of interventions of this type poses all kinds of problems
And if it were possible to treat forms of depression that “resist” drugs (a phenomenon that affects 30% of patients), and do not even respond to electroconvulsive therapy, with a kind of brain pacemaker? A device implanted in the brain that sends impulses capable of “resetting” its functioning? Moreover, it is able, just like a pacemaker, to function (in this case not acting on the heart, but on the brain circuits related to depression) only when needed, that is when the symptoms become more severe and suicidal ideas arise. ?
The experiment (because we must speak of an experiment and certainly not a study since it was conducted only on one person), was attempted at the USFC, University of California San Francisco, where a group of researchers implanted a brain device in a 36-year-old woman afflicted for years by a form of severe and incurable depression. The results, according to the patient herself, seem excellent. But there are many “buts”.
The limits and uncertainties
Explains Giancarlo Cerveri, director of the Mental Health Department of Lodi: “Devices of this type have been used for years in the treatment of Parkinson’s, epilepsy and, more recently, also in Obsessive Compulsive Disorder, but in these cases they are stimulated , or to inhibit, the activity of brain areas that we well know are those suffering: in the case of depression where to go to act? The brain circuits involved in depression are many and complex. In the aforementioned experiment, the site that sends signals was identified in the amygdala that would “trigger” the alarm and thus induce the implanted device to send “regulatory” electrical impulses to the striatum. Now, we actually know that the amygdala (part of the limbic system, with a fundamental role in emotional responses) plays a role in depression, but is its eventual “malfunction” the cause or the consequence of the disease? In other words: are we sure that the depression originates “there” or is the “source” to be sought elsewhere? The striatum is known for its role in the planning and modulation of movements, but we also know that it is activated by stimuli such as those associated with reward, aversion and, in particular, the “ventral striatum” is connected to the ability to feel pleasure, “zest for life”, often lost in severe forms of depression. Is that enough to say that it is precisely in these areas that we need to act? We are more complex than that. Especially since depression is especially typical of man, one would think it is not linked to “ancient” brain structures of the deep central nervous system. like those mentioned above, but to other “younger”, more “superficial” ones, developed later in the course of evolution and localized in the cortex “
The other “physical” methods of treatment
This is certainly not the first time that we think of using “physical” means in the treatment of depression, we already resort to stimulation of the vagus nerve and transcranial magnetic stimulation.
«In the first case – clarifies Cerveri – we resort to a transcutaneous auricular stimulation and we act on this particular nerve because we know that, among other things, it regulates the response to anxiety and stress; in the second case, with a kind of “helmet” equipped with magnets, areas of the deep central nervous system are stimulated. Applied repetitively, magnetic pulses modulate the connections between neurons, known as synapses, and hence brain activity. This technique is also used to address addictions, such as drug and alcohol addictions. Warning: these are not methods capable of replacing “traditional” therapies. Even the treatment with white light, widespread especially in Northern countries, lacking in sunlight, is a “physical” cure and gives good results in seasonal depression “
Invasiveness and risks
The big difference between the latter “physical” therapies and the one attempted now in America is that the former are non-invasive. The device used by the Californian colleagues, on the other hand, provides for a brain implant of electrodes and that of a “control unit” to generate the impulses, positioned under the collarbone. As always in surgery there are risks, albeit low, of bleeding and infections and then a malfunction of the system can occur, unwanted side effects can occur and, of course, the “control unit” must be replaced periodically. And then there are the psychological resistance: it is difficult to accept the idea of having a fixed device implanted in the brain “
«This is a“ pioneering ”intervention, it is unthinkable that it will soon be routinely proposed, but it is part of a long line of research for alternative solutions to those already known; it could be thought of as a “lifesaver” in cases where the suicidal risk is high and all other treatments have failed. In any case, attempts of this type can increase our knowledge of the brain and its functioning AND of “depressions” and it is no coincidence that I use the word in the plural »concludes Cladio Mencacci co-president of the Italian Society of Neuropsychopharmacology.
October 5, 2021 (change October 5, 2021 | 16:35)
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