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How a 'pacemaker for the brain' treats a woman's severe depression

When the experimental implant recognizes that a depression circuit is active, it stimulates an area of brain that alleviates her symptoms.

In the summer of 2020, Sarah waited in a room at UC-San Francisco with a black box attached to her skull. The device sent electrical impulses to different parts of her brain, with the goal of discovering how to relieve her severe depression. She then became the very first patient to receive a new experimental implant of what some researchers call a "pacemaker for the brain." 

Click the video above to hear more from Sarah and see how the device works.

"My daily life had become so restricted and impoverished by depression, that I felt tortured by each day," said Sarah, who is keeping her last name private. "I forced myself to resist the suicidal impulses that overtook me several times an hour."

Over the course of many years, Sarah tried a number of treatments for her severe depression. None of them worked. Now after more than a year living with the device called the NeuroPace RNS system implanted in her brain, Sarah says her depression is being kept at bay.

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Sarah, clinical trial participant, at an appointment with Katherine Scangos at UCSF's Langley Porter Psychiatric Institute.

Maurice Ramirez/UCSF

"When the researchers implanted the device and turned it on for the first time, my life took an immediate upward turn," she said. "Hobbies I used to distract myself from suicidal thoughts suddenly became pleasurable again. I was able to make small decisions about what to eat without becoming stuck in a morass of indecision for hours."

The device monitors Sarah's brain activity for what researchers call Sarah's depression circuit, a specific pattern that occurs when her depression symptoms kick in. Researchers identified the depression circuit by spending 10 days monitoring Sarah's neural patterns, stimulating different areas of her brain and tracking mood changes. Their work was published in the journal Nature on Oct. 4.

When the device recognizes the depression circuit is active, it stimulates the area of Sarah's brain that researchers found best alleviates her symptoms. "It functions in an automated mode where it's keeping her depression in a way where it's not present, kind of like a house thermostat." Andrew Krystal, a professor of psychiatry at UCSF, told CNET.

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Implanted DBS with one lead (blue) in the amygdala to detect neural activity associated with depression symptoms, andthe other lead in the ventral capsule/ventral striatum, the region where stimulation elicited the best mood response in the study participant.

Ken Probst, UCSF

"Where a thermostat might keep your temperature in your house level, this keeps the depression from increasing. When it starts to increase, stimulation kicks in and normalizes it." he said.

This type of stimulation is known as deep brain stimulation, or DBS. It's already used to treat epilepsy and has been studied in the past to treat depression. But this new research is the first to customize the treatment for a depressed patient.

UCSF has two more patients lined up to undergo the treatment. Researchers hope to test it on a total of 12 people.