Radical new neurosurgical treatment that accurately targets brain networks involved in depression is being pioneered for the first time in the world at Frenchay Hospital in the city of Bristol in the UK.
The new treatment includes experimental antidepressants, deep brain stimulation and stereotactic neurosurgery, and the research team at the University of Bristol and North Bristol NHS Trust hope it will help people suffering with severe and intractable depression.
The first patient to receive the treatment is 62-year-old grandmother Sheila Cook from Torquay. She had been fighting a long hard battle with depression for more than a decade, and has tried to commit suicide more than once in that time.
North Bristol NHS Trust reported in a statement on Monday that Cook is beginning “to enjoy life again”. She said her life has changed and she feels happy for the first time in years.
The research team has two leaders, Dr Andrea Malizia, a Consultant Senior Lecturer in the School of Social and Community Medicine at the University of Bristol, and Mr Nikunj Patel, a Senior Clinical Lecturer in the Department of Neurosurgery at North Bristol NHS Trust.
Cook’s illness had stopped responding to conventional treatments when she was offered deep brain stimulation and to undergo the first trial in the world to stimulate two different brain networks involved in depression.
But the deep brain stimulation only resulted in a temporary response, and was not sufficient to make her well. However, following further advanced stereotactic neurosurgery in early 2010, she is now well, said the Trust.
Cook’s story was covered in the BBC 1 television program “Inside Out West”, broadcast in the evening of Monday 24 January.
Deep brain stimulation is where electrodes connected via thin wires to a “pacemaker” are inserted deep in the brain via holes drilled in the skull.
By delivering short bursts of electricity, the electrodes stimulate or inhibit brain circuits specific to the condition being treated. In this case, the circuits targeted are relevant to depression and are thought to regulate internal drives, monitor emotion, and help control the integration of emotion with bodily and intellectual function.
Deep brain stimulation does not work in every case and some patients just aren’t suitable for it.
However, an alternative method specifically developed at Frenchay, which Cook is the first patient to receive, is a surgical procedure called “Anterior Cingulotomy”, using implantable guide tubes.
While anterior cingulotomy, which removes the anterior cingulate cortex as well as the fibers of the cingulum, is already a recognized neurosurgical procedure for severe depression, the approach developed at Frenchay is much more accurate.
Malizia told the press that:
“Our patients and their families suffer enormously and it is often thought that nothing else can be done.”
“This lady responded temporarily to two of the complex treatments that we initiated in Bristol, but in the end remission has only been achieved by persisting and moving on to the next advanced treatment,” he added.
Malizia said the team wished to thank all the patients and their relatives, who despite depression destroying their lives, carry on bravely, fighting the illness year after year.
He also thanked the League of Friends at Frenchay hospital who have donated the deep brain stimulation equipment and whose support has been essential in getting the new treatment off the ground.
About 1 in 5 people experiences some form of depression at least once during their lifetime. About half of them get well within six months, but around ten per cent can suffer for three years and more, after which the chances of becoming well again are significantly lower.
Chronic depression is severely disabling. Many people with this disease lose their jobs, are on state benefits, have to move home or lose their family. They suffer high levels of personal distress and about 15 per cent die by suicide.
Cook, started to feel down and depressed about 10 years ago: she felt stressed at work, stopped eating, and began to experience feelings of not being able to cope, to the point that it got in the way of everyday life. At that time she was an experienced and senior nurse.
She told the press that:
“It just crept up on me, I felt awful and didn’t know why.”
Her GP referred her to a local mental health trust where she started a course of medication with support from a social worker. But things got worse, to the point where she had to be admitted to hospital for weeks at a time, and began receiving electric shock therapy (ECT).
“The ECT helped but it didn’t last and in the end my husband had to give up work and we relocated to Torquay because we thought I would be happier by the sea,” said Cook.
At first the change of scenery seemed to do the trick, but the symptoms returned in a few months, and she went back to her GP, had more ECT, and then that stopped when doctors thought it would be unsafe to give her any more.
That was when “things became really bad,” said Cook, “I didn’t want to go out. I’d sit in all day and think bad thoughts”.
Eventually she was referred to the University of Bristol’s Psychopharmacology Unit, who, together with the Neurosciences Department at Frenchay Hospital, were beginning to investigate new treatments for depression including deep brain stimulation, an approach that was already showing dramatic results in patients with motor illnesses such as Parkinson’s disease.
Cook said they asked her if she was interested in taking part in a clinical trial, and that was how it all started.
She underwent the initial deep brain stimulation treatment, but the symptoms returned, even though initially it seemed to work.
Then in February 2010 she was asked if she would like to undergo trial of a new type of treatment, ablative neurosurgery using guide tubes. She thought about it carefully and agreed.
“The effects were remarkable,” said Cook.
“Within a few weeks my life changed,” she added, “I felt happy for the first time in years and began to take an interest in life again.”
She rediscovered books, did the housework, and went for walks. But perhaps the most important thing is, as she explained:
“I’m now rediscovering my family and my wonderful grandchildren so much so that we are now planning to move to be nearer to them.”
“I cannot thank the clinicians and researchers who worked with me enough – they have given me my life back,” she said.
Source: North Bristol NHS Trust (press release 24 Jan 2011).
Written by: Catharine Paddock, PhD