Severe depression can be treated with a pacemaker, study points out

The pacemaker, medical equipment used for decades mainly for heart problems, may have another new function — the treatment of depression. A new study, partially carried out in Brazil, evaluated the effects that the tool can have against psychiatric illness and found a very significant improvement in patients as a result.

Normally associated with cardiac rhythm marking, the pacemaker has had many developments since the 1960s. With it, it is possible to treat brain diseases because the brain “receives electrical commands very well and we are able to control symptoms of various diseases”, says Antônio De Salles, neurosurgeon at Hospital Vila Nova Star, Rede D’Or, and research coordinator.

The doctor says that, currently, the equipment is already known for the treatment of epilepsy, Parkinson’s, tremors and chronic pain, for example. Depression is one of the diseases being investigated using the tool, as is Alzheimer’s.

The instrument is responsible for emitting electrical pulses that act on neurons, which are brain cells. These pulses can be manipulated in different factors depending on the purpose you want to achieve, such as frequency, intensity and size. It is from these pulses that it is possible to manipulate brain functions to treat some diseases.

For example, if a patient has a tremor, it is possible to identify the brain neurons that are related to muscle control. From there, electrical pulses can be transmitted during surgery to see if the tremor stops. If that happens, “we know that if we keep these electrical pulses through a pacemaker implanted in the patient, he will no longer have the tremor”, explains Salles.

This model, based on the manipulation of brain functions, is similar to what happens with drugs, but the pacemaker has the advantage of not causing side effects in patients.

“We enter with these [drogas] so they manipulate the chemical part of the brain. The problem with medications is that they enter the whole body, and then we have side effects related to various medications.”

Since the pacemaker is linked to specific areas of the brain, it “only works there and [naquelas] electrical networks, so no [atinge] other parts of the body”.

With the research, Salles’ idea was to prove that, through the ophthalmic nerve that is under the eyebrow, it would be possible to carry “electrical impulses to the brain and these impulses [manipulariam] the chemistry related to depression.” These impulses, in this case, could be transmitted by a pacemaker.

To prove this concept, the neurosurgeon carried out the investigation that began about five years ago and included the participation of 20 patients diagnosed with the disease. These participants were divided equally into two groups—one that actually had the treatment (experimental) and the other that was the control.

With the constant stimulation that the pacemaker causes in the ophthalmic nerve, Salles says that it was possible to see a significant improvement for the experimental group.

“To people [acompanhou os pacientes] too long to be sure [da melhora]”, says the neurosurgeon, also indicating that most participants in the experimental group managed to do actions that were not possible before, such as leaving home, working and having romantic relationships.

One of these patients was publicist Márcia Castrillo. She was diagnosed with severe depression in 2007. “It felt like my life was over. I didn’t even have the strength to go to work, I had a lot of migraine and pain,” she says.

Castrillo says that he sought out several doctors and treatments “to try to get better, because there was a lot of sadness and lack of courage”. In total, she was treated with seven antidepressants, in addition to psychological follow-up. Even so, the years went by and there were only a few occasional improvements, so her feeling was that the treatment wasn’t working.

In 2014, the publicist discovered the research coordinated by Salles and signed up. She went through screening for the study and passed. In January 2015, surgery for pacemaker implantation was performed.

“I went every week to the [hospital] for follow-up after surgery and I had a huge questionnaire to answer and I answered the worst possible condition. […], but as time passed, I noticed that the answers were getting better. In a year, I was already answering everything in the best possible scenario”, he says.

In addition to improving the depressive condition, Castrillo also says that other problems arising from the disease were disappearing, such as the migraines she had constantly.

The complete improvement came after approximately two years of surgery, which is when she stopped taking antidepressants and also stopped taking therapy.

Even though there are positive signs in the use of pacemakers to treat this disease, Salles himself reiterates that further studies are needed.

Currently, the neurosurgeon is already planning a new survey with a larger number of patients — according to him, the idea of ​​this second investigation is to have 200 participants separated between the experimental and control groups to have even more concise results about the pacemaker.

“It’s a treatment that we’ve shown that it works, [mas] we still don’t recommend it to everyone indiscriminately because [foi só] a survey,” he says.