Pi c t u r i n g depression Patients diagnosed with treatment-resistant depression— occurring in approximately 1 percent of Americans—describe living in a perpetual cloud of darkness. “All I could do was get out of bed and go to the kitchen. It didn’t matter what I would eat because it all tasted the same,” said one young man who wishes to remain anonymous. “I only ate so I wouldn’t end up in the hospital.” Before coming to Emory, candidates for DBS therapy in 40
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the a r t o f Pr eci s i o n : Helen Mayberg is using sophisticated computer models of the brain to help optimize treatment for depression.
Mo d e l B e h av i o r : Digital images created by Michael Konomos help to advance teaching and treatments.
Mayberg’s most recent study had tried an average of more than twenty medications or combinations of medications. Of the thirty subjects in the study, twenty-nine had received ECT. None of these treatments worked for this highly resistant group. With hope for a better outcome, they elected to receive DBS, in which a battery-powered device is surgically implanted into the chest and connected to two wires inserted directly into the brain. Patients
remain awake during the procedure to report their feelings as physicians remotely activate four electrical contacts within Area 25, a part of the brain that regulates mood. It can be a frightening prospect for patients, but using improved 3-D brain images to help guide surgeons may make the treatment more efficient and effective. Traditionally, anatomical landmarks and MRI scans of the patient’s brain taken prior to surgery
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ayberg heads a multidisciplinary program at Emory dedicated to studying depression and the effects of antidepressant treatments, including DBS. She and her research team have developed reconstructions of the human brain—computer models based on imaging data gathered from actual patients—to personalize the selection of a best treatment, be it cognitive behavior therapy, medication, or DBS, based on brain scan patterns. The team’s most recent imaging studies also are being used to refine and optimize the surgical targeting for patients undergoing DBS. Mayberg pioneered the use of DBS in a region of the brain known as Area 25 more than ten years ago. Her team is testing to determine if these new computer reconstructions can improve the targeting of Area 25 and adjacent white matter bundles critical to achieving antidepressant effects. People with severe depression that does not respond to talk therapy, drugs, electroconvulsive therapy (ECT), or a combination of these treatments participate in Mayberg’s research. Some participants have struggled with depression for most of their lives.