New therapy approach in the treatment of depression

Therapy for depression

New surgical therapy approach in the treatment of depression

At the University Hospital Heidelberg, which is particularly renowned in the field of biomedicine, neurosurgeons led by Dr. Ing. Karl Kiening, section head of Stereotactic Neurosurgery, performed a worldwide unique procedure. On a 64-year-old patient who has suffered from depression for 46 years, according to the hospital, who has already made two suicide attempts in the course of her suffering history, electrodes were successfully implanted in a small double-sided structure in the center of the brain. In the past, the woman had already been treated unsuccessfully with electroconvulsive therapy and medication.

On 3 June this year, the neurosurgeons implanted two electrodes for stimulation of the habenulae (Latin: Habena = reins), which also used epiphyseal styles, using a novel intra-operative high-field nuclear spin device, which serves to check the accuracy of the implanted wires and electrodes to be named.

Scientific background of the operation
The German Dr. Alexander Sartorius, from the Central Institute of Mental Health in Mannheim, and the US psychiatrist Prof. Fritz A. Henn (formerly head of the Mannheim Institute), from the American Brookhaven National Laboratory in New York, published in 2007 the thesis that the lateral habenulae as a superior control system for serotonin and norepinephrine releasehave a strong influence on depression symptoms („Deep brain stimulation (DBS) of the lateral habenula“). Hyperactivity of the habenulae therefore leads to a regulation of the serotonin, noradrenaline and dopamine system, which is also repeatedly associated with depression. So far, in biochemical treatment approaches, in connection with the so-called monoamine thesis,In the case of depression, it is always attached to the rather subordinate structures with medication or with stimulation.

Effectiveness and future in the treatment of depression
Due to an accident of the patient, after which an ECG was to be carried out due to a zygomatic fracture, the electrodes had to be switched off in the patient for a few days in November. Thereupon the depression set in again. After reconnection and renewed stimulation of the habenula, however, the condition of the patient stabilized after a few weeks. This was interpreted by the physicians involved as provable evidence of the success of the procedure.

The psychiatrists from the Central Institute of Mental Health in Mannheim and the neurosurgeons from the Heidelberg University Hospital are now working together to conduct a clinical study on habenula stimulation in severely depressed patients at five German psychiatric neurosurgical centers.

The Mannheim and Heidelberg institutions are internationally recognized centers in areas such as modern biomedical and psychiatric research. Thus, it is to be expected that the new findings, in the most effective possible treatment of depression, will represent a major step forward for those affected to improve their quality of life. (09.01.2010)