APA Daily Bulletin - Day 3, 2008 - (Page 8) Tuesday The Daily BULLETIN 8 May 6, 2008 FRONTIERS OF SCIENCE LECTURE Lecture examines deep brain stimulation in treatment-resistant depression Monday morning, Helen Mayberg, M.D., offered optimism and hope for psychiatrists with patients who have not responded to treatment for their depression. Dr. Mayberg, professor of psychiatry and neurology at Emory University School of Medicine, discussed the potential of “Deep Brain Stimulation for Treatment-Resistant Depression” as part of the Frontiers of Science Lecture series. The lecture was a collaborative session with the National Institute of Mental Health. Dr. Mayberg began by walking attendees through the process she undertook to develop a hypothesis and then to test the use of deep brain stimulation in treatment-resistant patients. First, her team had to identify the problem and determine a target for stimulation. “It may be — as in Parkinson’s — that it isn’t just ‘what’s the illness circuit’ but what part of that circuit might be most important to modulate,” Dr. Mayberg said. She said these early investigations to defi ne the “ground rules” of this experiment sought to pinpoint such things as response pathways, an optimal target area, and appropriate patients. Dr. Mayberg shared the results of several imaging studies that helped her to identify Area 25 as a potential key to helping patients with treatment-resistant depression. “Our hypothesis was that we can be more specific about this network. That perhaps the problem is when Area 25 comes online in the setting of a stressors, the brain’s ability to compensate for that is what we’re dealing with,” she said. “And the thinking for people who have no compensatory response at all is maybe we just ought to go after the problem at this theoretical origin.” Dr. Mayberg said the evidence that Area 25 plays a significant role in the illness circuit can be seen by the “company it keeps.” She said Area 25 is known to affect such processes as cortisol regulation and stress response, sleep modulation, and emotional response. It also is tied to the amygdala and the hippocampus. “It sits as a central locator that can influence stress responses, circadian regulation, motion regulation, motivation, and drive,” Dr. Mayberg said. “It’s sort of at a hub that can wreak havoc on all the systems that we see as core in major depression. So that gave us pause as we contemplated the use of brain stimulation.” Dr. Mayberg then revealed the details and results of an initial study (initiated at the University of Toronto) to test whether deep brain stimulation at Area 25 could successfully reverse treatment-resistant depression. The pilot study, which was published three years ago, had six subjects — three male and three female — who had exhausted all other treatment options. All six were on disability and unable to work. Following surgery to implant three contacts in the brain, patients were asked to report any changes to the researchers although they did not have any indication of what was happening. Dr. Mayberg said patients who responded to the treatment (four of six) commonly indicated a change when the third contact reached four volts. She said patients described “a sudden sense of calmness” or feeling quiet, relief, or lightness. This was quickly followed by an increased interest, energy, and awareness as noted by researchers. In addition to these acute results, Dr. Mayberg shared results from the following six months and reported that the four responding patients remain well today — five years later. “Those who got well, stayed well,” she said. “They beat the odds.” She also shared results from further studies that had similar results. While these studies clearly offer hope for patients who have not responded to other treatments, Dr. Mayberg had a word of caution. “Treatment is not over after implantation,” she said. “Behavioral rehabilitation is still needed for these patients.” During the past 20 years, Dr. Mayberg’s re s e a rch h a s s y stem at ic a l ly e x a m i ned neural mechanisms mediating depression pat hogene s i s i n bot h ps ych i at r ic a nd neurological patient subgroups, as well as antidepressant response to various treatments i nclud i ng ph a r m acot her apy, cog n it ive behavioral therapy, and placebo, with a goal towards identification of neurobiological markers predicting treatment response and optimized treatment selection. What are you waiting for, an engraved invitation? well, here it is! ARICEPT® is a registered trademark of Eisai Co., Ltd. ARU00348A © 2008 Eisai Inc. and Pfizer Inc. All rights reserved. Printed in USA/April 2008
Table of Contents Feed for the Digital Edition of APA Daily Bulletin - Day 3, 2008 Contents Campus Violence Health Technology Frontiers in Science APA Daily Bulletin - Day 3, 2008 APA Daily Bulletin - Day 3, 2008 - Contents (Page 1) APA Daily Bulletin - Day 3, 2008 - Contents (Page 2) APA Daily Bulletin - Day 3, 2008 - Campus Violence (Page 3) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 4) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 5) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 6) APA Daily Bulletin - Day 3, 2008 - Health Technology (Page 7) APA Daily Bulletin - Day 3, 2008 - Frontiers in Science (Page 8)
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