BY LAURAN NEERGAARD
It's a new frontier for psychiatric illness: Brain pacemakers that promise to act as antidepressants by changing how patients' nerve circuitry fires.
Scientists already know the power of these devices to block the tremors of Parkinson's disease and related illnesses; more than 40,000 such patients worldwide have the implants.
But psychiatric illnesses are much more complex and the new experiments with so-called deep brain stimulation, or DBS, are in their infancy. Only a few dozen patients with severe depression or obsessive-compulsive disorder so far have been treated in closely monitored studies.
Still, the early results are promising. Dramatic video shows one patient visibly brightening as doctors turn on her brain pacemaker and she says in surprise: "I'm starting to smile." And new reports this month show that some worst-case patients -- whose depression wasn't relieved by medication, psychotherapy, even controversial shock treatment -- are finding lasting relief.
Six of 17 severely depressed patients were in remission a year after undergoing DBS and four more markedly improved, and more than half of 26 obsessive-compulsive patients showed substantial improvement over three years, say studies from a team at the Cleveland Clinic, Brown University and Belgium's University of Leuven.
"Not all patients get better, but when patients respond, it's significant," says Dr. Helen Mayberg of Emory University, who has implanted about 50 depression patients. Her first remains in remission after five years; she estimates that four of every six show enough improvement to be classified "responders."
The rationale behind DBS is credible, says Dr. Wayne Goodman of the National Institute for Mental Health: Surgery sometimes helps worst-case patients by destroying misfiring patches of brain tissue. The electrodes are placed into similar spots, but don't destroy tissue -- the electrical signals can be adjusted and turned off.
But it's not yet ready for prime-time, Goodman cautions. He worries that because the electrodes already are widely available, centers without proper training will start offering the $40,000 implant surgeries to psychiatric patients before science proves if they're really valuable.
"It is an invasive, experimental procedure," he warns, with risks including bleeding in the brain and infections. He calls DBS "the last resort for stringently selected patients."
Still, Diane Hire of Cleveland, the patient whose first smile was recorded, illustrates the hope.
The 12-year Navy veteran was medically discharged for depression and spent a decade on disability, unable to function. "I basically felt like a dead person walking. I had no feelings, no emotions," she told the scientists' meeting.
Her DBS was switched on in January 2007, and "my whole world changed," says Hire, 54. She's not back to work yet: "It is a real challenge to learn how to live as a healthy person again," she adds, saying she doesn't handle stress or multitasking well. But, "I wake up every day looking forward to what's ahead."
