What Makes Up Your Mind:
Deep Brain Stimulation
with Dr. Mahendra Bhati
Our topic on this episode of What Makes Up Your Mind takes us deep into the human brain where stimulation treatments show great promise for relieving psychiatric illnesses. Already used to treat neural conditions affecting motor skills like epilepsy and movement disorders such as Parkinson’s disease, Deep Brain Stimulation (DBS) has also been beneficial in the treatment of severe Obsessive-Compulsive Disorder (OCD) and is being tested for treatment-resistant severe depression. Our guest, Dr. Mahendra Bhati, says DBS has the potential to treat many mental illnesses.
Dr. Bhati, Clinical Professor of Psychiatry and Behavioral Sciences and Clinical Professor of Neurosurgery at Stanford, was an investigator in the first controlled clinical trials of DBS for depression, and remains at the forefront of neuromodulation therapy research, including ongoing work with neurosurgeons to employ Deep Brain Stimulation. He’s also part of the team at the Stanford Interventional Psychiatry Clinic and Brain Stimulation Lab offering these specialized device-based interventions in clinical and research settings:
Transcranial Magnetic Stimulation (TMS)
TMS is an FDA-approved treatment for major depression and obsessive-compulsive disorder. It is non-invasive and involves the repeated application of brief magnetic pulses to the brain. TMS is a safe, non-invasive, outpatient procedure shown to help patients who have not benefited from antidepressant medication. We offer TMS at Stanford and have multiple devices capable of providing personalized therapy. TMS is associated with few side effects, the most common being mild scalp discomfort during treatment.
Electro-convulsive Therapy (ECT)
ECT is a highly effective treatment most often used in severe cases of depression and catatonia. It is the oldest and most effective treatment for depression. It is a non-invasive procedure involving use of brief general anesthesia and electrical stimulation to induce a controlled, generalized seizure. ECT has been shown to be a rapid and robust treatment for depression when medications and psychotherapy are ineffective. It is particularly effective for treatment of geriatric depression and is often a treatment when no others are effective. ECT is associated with memory side effects which can be minimized with use of techniques such as right unilateral, ultra-brief ECT.
Vagus Nerve Stimulation (VNS)
VNS is an FDA-approved treatment for treatment-resistant depression and epilepsy. It involves surgical implantation of a device similar to a pacemaker which is attached to a wire connecting to the Vagus nerve in the neck. VNS is considered an invasive treatment since implantation of the device requires minor surgery. VNS is not widely available due to limited insurance coverage. It is associated with few side effects, the most common being hoarseness or changes in voice.
As we focus on Deep Brain Stimulation (DBS) in this conversation, the Stanford Interventional Psychiatry Clinic describes it this way: DBS is an FDA-approved treatment for conditions including Parkinson’s disease, tremor, and obsessive-compulsive disorder. It is an invasive procedure involving neurosurgical implantation of brain electrodes connected to a pulse generator to directly modulate brain circuits and activity. Despite its invasive nature, DBS is considered reversible and associated with few side effects.
In our podcast, you’ll hear Dr. Bhati give an in-depth description of the DBS procedure itself, the results he’s seen, and his process for evaluating candidates for the procedure. He explains the criteria for using DBS to treat OCD is severe treatment resistance, while using DBS for severe treatment-resistant depression is currently only available through a research study.
In terms of documented efficacy for depression, Dr. Bhati says past studies done as “open label” investigations in which both researchers and participants are aware of the treatment being given showed positive results from DBS. Later controlled studies did not show greater positive results than so-called “sham treatments” in which the doctor simply goes through the motions without performing the treatment, not unlike using a placebo in a blind study for a pharmaceutical. However, according to Dr. Bhati, on-going studies continue, using advanced tools like neuroimaging to better characterize patients and neural circuits, as well as investigations of longer duration, to seek better outcomes.
While extremely optimistic and excited about the possibilities DBS holds for alleviating the suffering of psychiatric patients, Dr. Bhati is concerned about how accessible this and other developing treatments will be, and currently are, for those who need them. One impediment is the shortage of mental health care providers in this arena, so Dr. Bhati directs a clinical fellowship in interventional psychiatry to encourage more young psychiatrists to engage in these new treatment options.
To add to our fascinating discussion, Dr. Bhati shares his interest in the role of consciousness in mental illness and healing. Click through to listen, and check the links below for more on Dr. Bhati’s work and where DBS patient trials may be available, including at the Stanford Brain Stimulation Lab.