An Australian woman, last month, became the first person to undergo a surgery for depression in Mumbai. The 38-year-old underwent Deep Brain Stimulation (DBS) surgery after having struggled with depression for 26 years, and suffering to the point that her body had stopped responding to traditional treatment methods.
But what is DBS surgery? Who can undergo it? Who is it recommended for? Can it ‘cure’ depression? What exactly happens in this surgery?
FIT decodes it all for you.
Deep Brain Stimulation: Surgically Improving Movement-Restricting Issues
DBS is a neuro-psychiatric surgery that “involves modifying the symptoms of an illness by modulating the nervous system,” explains Dr Akshat Kayal, Consultant, Neurosurgery, Kokilaben Dhirubhai Ambani Hospital, who recently conducted this surgery on a 65-year-old Parkinson's disease patient with severe mobility issues.
What exactly happens in this surgery is that electrodes are implanted within the patient’s brain through which electric signals are passed to the brain.
Dr Kayal says that these signals control movement, block abnormal nerve signals, and alleviate the symptoms the patient might be facing.
Dr Sudhir Kumar, Neurologist, Apollo Hospitals, Hyderabad, concurs. He adds that pre-surgery, based on CT, PET scans, and functional MRIs, certain parts of the brain that cause the symptoms/condition are identified, indicating where the electrodes need to be implanted.
But that’s not all. A pacemaker is also inserted in the chest or upper abdomen.
These two implantations together are directed to change the activity of the brain neurons and alter the neural circuits.
Interestingly, this is the first psychiatric surgery performed in the country since the passing of the Mental Healthcare Act in 2017.
But can this be recommend to every patient suffering from depression?
Ideal Candidates, Pros, & Cons: What You Should Know About DBS
Not really. For now, the United States Food and Drug Administration has approved this surgery only for four movement-related neurological conditions and one psychiatric condition. These include:
Obsessive Compulsive Disorder
DBS can help them with symptoms like dyskinesia (involuntary movements), mobility issues, motor fluctuations.
But even for these conditions, it’s not recommended for all patients, only for those whose bodies have proven medically resistant to treatment.
Dr Kayal shares that a “multidisciplinary team of specialists, including neurologists and neurosurgeons,” takes into consideration factors like whether medication has proved insufficient, if it has severe side effects, if no other treatment is working for the patient, if the surgery will significantly improve their quality of life, etc.
However, when it comes to depression, the FDA has only allowed for DBS to be conducted as an “experimental surgery,” and has not approved it yet.
Dr Kumar tells FIT:
“For depression, the first line of treatment is medication, along with counselling and psychotherapy. 70 out of every 100 patients respond to these. But that does not mean that all the other 30, who are medically resistant to these treatments, would require DBS.”
Currently, DBS is offered only to those with severe or very severe depression and have exhausted all forms of medical treatment available.
The cost of the surgery also significantly restricts who DBS might be accessible to. In India, the surgery can cost anywhere between Rs 8-15 lakh.
Risks Associated With DBS
But even if someone does undergo DBS, there are certain risks associated with it.
Misplacement of leads
Bleeding or infection
Stroke or cardiovascular problems
Loss of speech
Loss of balance and vision
There’s one more risk associated with it, which is kind of (or extremely) counterproductive.
"The patients might have normal surgical side effects such as headaches, mood changes, loss of speech, etc, for a short while. But they might also have suicidal thoughts and tendencies.”Dr Sudhir Kumar
This is the reason, Dr Kumar says, that the surgery is not FDA approved yet for depression.
However, this side affect is not seen in every patient, as the neurons targeted are different for each one of them.
When it comes to depression patients, the neurons that are targeted do not cause this side effect, he assures.
Apart from the side effects and risks though, there’s another concern as well. Once the surgery has been performed, after a few weeks, the device is switched on and set according to the needs of the patient.
“Periodic fine-tuning of the electrical stimulations through constant titration becomes necessary,” says Dr Kayal.
What Kind Of Results Has DBS Shown Previously?
For the Australian woman who underwent the surgery last month, it’s too soon to say anything about the results DBS might have on her. The improvements, or side effects, show up after 6-9 months of the surgery.
But overall, DBS has shown significant results. Dr Kumar says that only a miniscule number of people globally (under 200) have undergone DBS for depression and about 20 percent have been in remission, with 35 percent of them showing improved symptoms as well.
When it comes to patients of movement-related disorders though, DBS has shown promising results.
“After undergoing DBS surgery, patients and their families can expect a reduction in tremors and improvement in symptoms such as stiffness, bradykinesia (slowness of movement), dystonia (sustained or repetitive muscle twisting, spasm, or cramp), and dyskinesia (involuntary movement). DBS can also help reduce the amount of medication that patients need, therefore minimising medication-related side effects.”Dr Kayal to FIT
According to Johns Hopkins Medicine too,
“Researchers who have followed patients after DBS have found that many patients continue to have improvements in their symptoms for several years after the procedure and are able to eat, use the bathroom and feed themselves.”