New therapeutic approach in depression treatment



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Therapy for depression

New surgical therapeutic approach in the treatment of depression

At Heidelberg University Hospital, which is particularly renowned in the field of biomedicine, neurosurgeons working with Dr. Karl Kiening, Head of the Section for Stereotactic Neurosurgery, carried out a worldwide unique procedure. Electrodes were successfully implanted in a small double-sided structure in the center of a 64-year-old patient who, according to the clinic, has been suffering from depression for 46 years and who has already made two suicide attempts in the course of her history of suffering. In the past, the woman had been unsuccessfully treated with electroconvulsive therapy and medication.

On June 3 of this year, the neurosurgeons implanted two electrodes for stimulation on the habenula (Latin habena = rein), which also have epiphyseal styles, using a new intraoperative high-field magnetic resonance device, which is used 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 for Mental Health in Mannheim, and the American psychiatrist Prof. Fritz A. Henn (formerly head of the Mannheim Institute), from the American Brookhaven National Laboratory in New York, published the thesis that the lateral habenulae as a superordinate control system for the release of serotonin and noradrenaline have a strong influence on depression symptoms (“deep brain stimulation (DBS) of the lateral habenula”). Hyperactivity of the habenulae leads to a downregulation of the serotonin, noradrenaline and dopamine system, which is often associated with depression. So far, in biochemical treatment approaches, in connection with the so-called monoamine thesis, in the case of depression, drugs or stimulation have always been applied to the more subordinate structures.

Effectiveness and future in the treatment of depression Due to an accident with the patient after an ECG was to be performed due to a cheekbone fracture, the patient's electrodes had to be switched off for a few days in November. Then the depression returned. After switching on again and stimulating the habenulae again, the patient's condition stabilized again after a few weeks. The doctors involved interpreted this as verifiable evidence of the success of the intervention.

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

The Mannheim and Heidelberg institutions are internationally recognized centers in areas such as modern biomedical and psychiatric research. It is to be expected that the new findings, in the most effective treatment of depression, will represent a major step towards improving their quality of life for those affected. (09/01/2010)

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