Health: Corners of the Mind; For some desperate patients, an electric current does what Prozac and talk therapy can't.(deep-brain stimulation to treat depression)

Byline: Clint Witchalls

At the age of 18, Rob Matte was a student, a competitive cyclist and an outgoing person with lots of friends. Then he fell into an emotional dark hole. For years Matte tried just about every treatment available for depression--antidepressant drugs, talk therapy and even 18 rounds of shock therapy. Nothing worked. All but two long-suffering friends had abandoned him. Relations with his family were strained. He had no interests and no job, and he spent most of his days in bed. He had began to think that the only way out was suicide.

Then in 2002, eight years after he was diagnosed with depression, Matte agreed to be a guinea pig for neurosurgeon Andres Lozano and Dr. Helen Mayberg at the Rotman Research Institute at Baycrest Centre and Toronto Western Hospital, who were testing a radical new treatment for depression called deep-brain stimulation. They implanted four electrodes deep into Matte's brain, ran wires down to his chest and hooked them up to a battery inserted under the skin. When they pressed a button, imparting a current to Matte's brain, it was as if a fog had cleared. "The operating room got brighter," he says. "It was like all the lights and colors got more vivid." Mood improvements soon followed. "I'm physically well," says Matte. "I'm feeling stronger. I'm able to do things." Matte has returned to his job as a laboratory technician.

For all the progress in drugs and talk therapy in the past two decades, one in five patients suffering from depression and obsessive-compulsive disorder--an estimated 50 million people in all--fail to respond to any of these treatments. Deep-brain stimulation is emerging as a potentially powerful alternative treatment. The idea behind DBS is that some patients suffering from mental illnesses show hyperactivity in some part of their brains. A small dose of electric current dampens neural activity, the theory goes, alleviating the problem as easily as turning on a light.

Doctors have had a long fascination with the notion of putting mental patients under the knife. Trephining, the 5,000-year-old practice of drilling big holes in the skull, was thought to release demons. The prefrontal lobotomy--which involved severing the nerve fibers that connected the frontal lobes with the thalamus, a region that processes sensory information--was widely performed on schizophrenics and paranoics and 1930s and 1940s, and in the 1950s was even used on homosexuals, unruly children and violent sociopaths. Doctors in the United States and Canada still practice psychosurgery on a few dozen patients a year--usually the most severe cases of obsessive-compulsive disorder and depression. Brain-imaging technology allows surgeons to pinpoint the exact location of hyperactivity in the brain and burn them with radiation. Although this procedure doesn't turn patients into zombies, as the lobotomy did, they carry the risk of stroke, infection and in some cases personality change. Deep-brain stimulation has one big advantage over radiation: it causes no permanent damage, and it is completely reversible.

DBS was ...