New Approach In Treatment Helps People With Severe Depression

People who experience chronic depression can be very severely disabling many lose their jobs while some lose their family.

Personal distress is high and about 15 per cent die by suicide.

Depression is an illness that affects about 20 per cent of people. About half, get well within six months while ten per cent of sufferers are still unwell after three years.

The proportion of people who get well is much reduced with only about one in ten getting better every year.

There are a number of conventional treatments for depression that include specific psychotherapies, different antidepressant medicines and electroconvulsive therapy (ECT).

Although 60 per cent of patients respond to the first antidepressant treatment, only about 10 per cent will respond to succeeding treatments.

ECT remains the most efficacious short-term treatment but it does not work for everyone.

A research led by Dr Andrea Malizia, Consultant Senior Lecturer in the School of Social and Community Medicine at the University of Bristol and Mr Nikunj Patel, Senior Clinical Lecturer in the Department of Neurosurgery at North Bristol NHS Trust, are pioneering a number of depression treatments including experimental antidepressants, deep brain stimulation (DBS) and stereotactic neurosurgery.

The patient, whose illness does not respond to conventional treatments, DBS treatment can be an option.

Deep brain stimulation consists of inserting thin wires in the brain that are connected to a ‘pacemaker’.

These monitor the regulation of emotion, oversee the integration of emotion with bodily and intellectual function and regulate internal drives.

Some patients do not respond to DBS or are not suitable for it, in which case the option of an ‘Anterior Cingulotomy’ using implantable guide tubes (GTAC) has been specifically developed.

This operation also modifies circuits that are important in emotion and the academics believe to be overactive in a number of psychiatric disorders.

The neurosurgical developments pioneered at Frenchay hospital make the surgery much more accurate and this will have an impact on increasing efficacy and decreasing side effects.

The Psychopharmacology and Functional Neurosurgery Service in Bristol provides complex treatments for these severely disabled people and aims to understand the brain changes underlying this disorder by using advanced brain imaging techniques and sleep recordings.

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