Depression deep brain stimulation

Aquizerate, B., Cuny, E., Martin-Guehl, C., Guehl, D., Amieva, H., Benazzouz, A., et al. (2004). Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Journal of Neurosurgery, 101, 682-686. 

Mayberg, H.S. et al, Deep brain stimulation for treatment-resistant depression. Neuron, 2005,45 651-660. 

Neurostimulators are much like cardiac pacemakers, except they apply small electrical signals to nerve tissue. Devices are available for spinal cord stimulation to manage chronic pain, vagal nerve stimulation to control epilepsy and deep depression, and deep brain stimulation to help relieve symptoms of Parkinson s disease and other neurological disorders. 

We propose that the therapeutic efficacy of ECT may be related to activation of specific brain areas and the whole brain need not convulse for an antidepressant effect. It is possible that neural discharge in specific brain regions [Bolwig 1984], and not the convulsion, is the key factor for ECT s antide-pressive effects. External electrical stimulation as used for ECT may depolarize deep brain regions only by induction of convulsion. Local electrical brain stimulation in humans is not possible, of course ECT initiates massive discharge in the central nervous system [Lerer et al. 1984], and activation of no specific brain area has been proven to be the cause for ECT s therapeutic action. Local electrical stimulation of various brain regions for examination of antidepressive effect in animal models of depression would be a tedious and complicated task. 

The above project represents a novel approach and a possible new treatment for psychiatric disorder. The possibility that neuronal discharge short of total brain convulsion may have psychiatric effects would be a major advance in understanding the action of ECT. Moreover, a possible substitute treatment for ECT would be a major clinical breakthrough. TMS might allow us to stimulate deep brain regions without convulsions, pain, or known hazards. Before one widens the use of TMS in humans, further evaluation of the effectiveness of TMS in animal models for depression is necessary. Our hypothesis is that ECT exerts its therapeutic effects by stimulation of specific brain regions. We suggest that TMS may exert therapeutic effects without need for total brain convulsion. 

Codeine (morphine methyl ether) resembles morphine in its general effect, but is less toxic and its depressant action less marked and less prolonged, whilst its stimulating action involves not only the spinal cord, but also the lower parts of the brain. In small doses in man it induces sleep, which is not so deep as that caused by morphine, and in large doses it causes restlessness and increased reflex excitability rather than sleep. The respiration is slowed less than by morphine (cf. table, p. 261). Cases of addiction for codeine can occur but according to Wolff they are rare. The best known ethers of morphine are ethylmorphine and benzyl-morphine [cf., table, p. 261), both used to replace morphine or codeine for special purposes. 

Neurotics affect the nervous system, brain, or spinal cord and may be either depressants or stimulants. Ethyl alcohol and drugs are examples of neurotic agents that cause exhilaration and then deep depression. 

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