Emily Hollenbeck struggled with a persistent and intense depression that she compared to a black hole. The gravity of her condition made it difficult for her to move and she was aware of the potential danger it posed. Sadly, both of her parents had also succumbed to their mental illness.

She was open to the idea of attempting something radical: Receiving implanted electrodes in her brain as a component of an experimental treatment.

Experts suggest that deep brain stimulation (DBS) could potentially benefit a large number of individuals, like the approximately 3 million Americans struggling with treatment-resistant depression. While currently approved for conditions such as Parkinson’s disease and epilepsy, there is optimism among medical professionals and patients that it will soon be more widely accessible for depression treatment.

The therapy administers precise electrical signals to patients, similar to a pacemaker for the brain. Recent studies have shown promise, with ongoing research. However, two major studies that did not find a benefit in using DBS for depression have temporarily hindered progress, and some researchers still have reservations.

The Food and Drug Administration has approved a faster review of Abbott Laboratories’ application to utilize their DBS devices for treating depression that is resistant to other forms of treatment.

Initially, I was amazed by the intensity of the concept. It felt like brain surgery, with wires being implanted in the brain. Hollenbeck, who is involved in ongoing research at Mount Sinai West, shared, “At that point, I had exhausted all other options and I was desperate for a solution.”

Hollenbeck experienced signs of depression during her childhood while living in poverty and dealing with bouts of homelessness. However, her most severe episode occurred during college, following her father’s suicide in 2009. She also faced another episode while working for Teach for America, which left her feeling paralyzed and concerned about losing her job and returning to poverty. This led to her being hospitalized.

“I experienced a fluctuating pattern,” she stated. Despite initially responding to treatment, she would later experience a setback.

Despite the loss of her mother during her final year of graduate school, she was able to successfully obtain a doctorate in psychology. However, the feeling of being consumed by darkness and despair always resurfaced. There were moments when she contemplated ending her own life.

She stated that she had tried every possible solution, even electroconvulsive therapy, before a doctor informed her about DBS three years ago.

She stated that none of the other methods were effective.

She was among a small group of individuals who received DBS treatment for depression, totaling only a few hundred.

During the procedure, Hollenbeck was sedated but alert. Dr. Brian Kopell, from Mount Sinai’s Center for Neuromodulation, implanted small metal electrodes into her subcallosal cingulate cortex, a part of the brain responsible for controlling emotions and influencing feelings of sorrow.

The electrodes are linked by an internal wire to a device implanted under her skin in her chest. This device regulates the level of electrical impulses and administers steady low-voltage pulses. Hollenbeck refers to it as “continuous Prozac.”

Medical professionals claim that stimulation is beneficial because electricity is able to communicate effectively with the brain. Neurons use both electrical and chemical signals to communicate.

According to Kopell, in typical brains, there is a free flow of electrical impulses throughout all regions, resembling a dance. However, in cases of depression, this dance becomes trapped within the brain’s emotional pathways. DBS has shown to release this blockage, allowing the brain to function as it should.

Hollenbeck stated that the impact was nearly immediate.

On the initial day following her surgery, her psychiatrist, Dr. Martijn Figee, noted a significant improvement in her mood and weight. She expressed to him that she was able to fully appreciate Vietnamese takeout, something she hadn’t been able to do in a long time. Additionally, she began to decorate her previously bare home, which she had left behind when she relocated to New York.

Hollenbeck’s biggest transformation was rediscovering joy in music.

“When I was feeling depressed, I found it difficult to enjoy music. It felt like all I could hear was static from a radio,” she shared. “But one day, while walking down the street on a sunny summer day, I was listening to a song and suddenly felt uplifted. I had this sense of wanting to keep walking and do things. That’s when I realized I was starting to feel better.”

She wishes that the therapy had been available for her parents.

For the past twenty years, Dr. Helen Mayberg, a neurologist, has been at the forefront of pioneering research on this treatment.

However, there were obstacles that came after. Several extensive studies conducted over a span of twelve years demonstrated that there was no noteworthy variation in the response rates between individuals who received treatment and those who did not. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, who is also studying DBS and depression, provided a couple of explanations for this. Firstly, the treatment was not tailored to individual needs, and secondly, the researchers only evaluated the outcomes over a short period of time.

New studies have revealed that patients with depression who underwent DBS experienced persistent relief over a long period of time. A 2022 study found that, on average, DBS for depression had a success rate of 60% across various brain regions.

Different teams are currently conducting trials for treatments that are specifically customized for each person. The team at Mount Sinai is a leading group in the United States that is researching the use of DBS for treating depression. They have a neuroimaging specialist who utilizes brain scans to pinpoint the precise area for Kopell to insert electrodes.

Mayberg, a leader in DBS research and the first director of The Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai, explained, “We have a model or plan in place that outlines our exact path.” She also noted, “Each individual’s brain is unique, similar to how people’s eyes and noses vary in size and placement.”

Different research groups also customize treatment for individuals, although their techniques may vary slightly. Scangos and her team are examining different targets in the brain and providing stimulation only when necessary for intense symptoms. She stated that the most effective treatment may ultimately involve a combination of methods.

Abbott is set to begin a major clinical trial this year as their teams continue to work, in anticipation of a potential decision from the FDA.

“The industry is making rapid progress,” Scangos stated. “I’m optimistic that we will receive approval in a timely manner.”

Some medical professionals remain doubtful, citing the possibility of complications like bleeding, stroke, or infection following a surgical procedure.

Dr. Stanley Caroff, a retired professor of psychiatry from the University of Pennsylvania, explained that the specific pathways and mechanisms in the brain that cause depression are still not fully understood. This makes it challenging to identify a specific area to target for stimulation. Additionally, choosing the appropriate patients for deep brain stimulation (DBS) can be difficult. However, there are already effective treatments for depression that have been approved and proven successful.

He stated that, in terms of psychiatry, the scientific evidence for using DBS to treat depression is lacking.

Hollenbeck recognizes that DBS has not been a complete solution; she continues to take medication for depression and requires ongoing treatment.

The doctor met with her in her office to talk about recovery. She was informed that the focus should not be on constant happiness, but rather on making strides towards improvement.

Currently, researchers are investigating methods of monitoring progress.

In a recent study published in the journal Nature, Mayberg and her colleagues discovered a means of assessing an individual’s current state at any given moment. By examining the brain activity of patients with DBS, they identified a distinct pattern that corresponds to their progress in recovery. This provides an objective method for monitoring improvement and differentiating between potential depression and normal changes in mood.

Researchers are verifying these results by utilizing more modern DBS equipment on a cohort of subjects which includes Hollenbeck.

She and other individuals contribute from their homes. She provides consistent brain recordings to researchers by using a tablet, placing a remote over the pacemaker-like device in her chest, and transmitting the data. She responds to prompts about her current feelings. Afterwards, she records a video that will be studied for facial expressions and speech patterns.

Periodically, she visits Mount Sinai’s “Q-Lab,” a virtual setting where researchers conduct quantitative studies by gathering various types of information, such as her movements in a simulated forest or the patterns she creates in the air with her arms. Similar to other participants, her arm movements have increased in speed since her condition has improved.

Data from recordings and visits are combined with other information, such as life events, to chart how she’s doing. This helps guide doctors’ decisions, such as whether to increase her dose of electricity – which they did once.

One morning, Hollenbeck adjusted her collar and swept her hair to the side, revealing scars on her chest and head from her DBS surgery. To her, these scars represent the progress she has made.

She navigates through the city by strolling in the park and visiting libraries, which provided solace during her childhood. She is no longer concerned that everyday obstacles will cause her to experience severe depression.

She stated that the pressure can be intense, but she is able to recognize and recall, even physically, that everything will be alright.

Without DBS, I most likely would not have survived until today.

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The AP Health and Science Department is funded by the Science and Educational Media Group of the Howard Hughes Medical Institute. The AP is fully accountable for all of its content.