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Freiburg is a leader in the field / Increasing evidence of effectiveness / Cause for hope for people suffering from the most severe forms of depression

It is estimated that ten to 30 percent of all people with recurrent depression do not respond to currently approved therapies such as medication and psychotherapy. Prof. Dr. Volker A. Coenen, Head of the Department of Stereotactic and Functional Neurosurgery at the Department of Neurosurgery, and his colleague Prof. Dr. Thomas Schläpfer, Head of the Department of Interventional Biological Psychiatry at the Department of Psychiatry and Psychotherapy, jointly performed the 70th deep brain stimulation on a severely depressed patient at the Medical Center - University of Freiburg in August. This means that the two experts have the most experience of this form of therapy in Germany.

Rapid, lasting relief after many failed therapy attempts

"Our patients have been struggling with severe depression for years. Deep brain stimulation led to significant relief within a few days for the majority of those treated. While other forms of therapy such as medication or psychotherapy often lose their effectiveness over time, our data show that the positive effect of deep brain stimulation seems to last for years," says Schläpfer. "The effectiveness and safety of the therapy has been increasingly confirmed in recent years," emphasizes Coenen. "For severely depressed people, deep brain stimulation may also be an effective treatment option outside of studies in a few years' time."

Deep brain stimulation is a procedure based on mild electrical stimuli that can be used to influence precisely selected areas of the brain. This procedure is considered standard for movement disorders such as Parkinson's disease and tremor. In cases of severe depression, electrodes are placed in the patient's medial forebrain bundle. These are then connected to a brain pacemaker. A weak electric current that is imperceptible to the patient stimulates the nerve cell clusters. Many of the patients treated by the clinical researchers as part of clinical trials had previously suffered from severe depression for between three and eleven years, for which neither drug or psychotherapeutic treatments nor stimulation methods such as electroconvulsive therapy brought any improvement.

Close collaboration between neurosurgery and psychiatry advances research

Schläpfer and Coenen have been working together for more than ten years and in several clinical studies on the stimulation of a specific target region: the medial forebrain bundle (slMFB) is considered the main regulator of the reward system and appears to be dysfunctional in severe depression. The Medical Center - University of Freiburg set up its own department years ago to research the stimulation of this region with deep brain stimulation in depression. The close collaboration between neurosurgery and psychiatry is unique in Europe. Other internationally renowned researchers, such as Helen Mayberg 's group at the Mount Sinai Institute in New York, are also working on deep brain stimulation for depression.

It is not yet known exactly what the stimulation does in the nerve cells. Apparently, it changes the activity in various brain centers and pathological oscillation circuits are interrupted. The procedure gives cause for hope for people suffering from the most severe forms of depression. However, it will probably be some time before deep brain stimulation is approved as a treatment method outside of studies. In order to further advance research in this field, the "Scientific Center for Deep Brain Stimulation" has been established at the Medical Center - University of Freiburg. The FORESEE III study, which has been conducted at the University Medical Center since 2018, is another important step on the way to approval as a standard therapy.

Contact:
Prof. Dr. Thomas Schläpfer
Head of the Department of Interventional Biological Psychiatry
Department of Psychiatry and Psychotherapy
Medical Center - University of Freiburg
thomas.schlaepfer@uniklinik-freiburg.de

Center for Deep Brain Stimulation
Medical Center - University of Freiburg
www.uniklinik-freiburg.de/wiss-zentrum-ths