Major depression is a mental health disorder that presents significant treatment challenges, leaving patients in despair despite yeoman-like efforts at change. Some patients adhere religiously to their therapy sessions, take prescribed meds, and effect lifestyle changes; despite that, they labor under this disorder. Too many believe the quest for relief is hopeless and will take their lives.
An additional concern is alcohol use disorders (AUD), where rehabilitation efforts may have been futile. AUD is viewed as a medical brain disorder. Lasting changes in the brain caused by alcohol misuse perpetuate AUD…(and) make individuals vulnerable to relapse.
But we are now in a decade of neuroimaging advances that allow us to peer inside the brain and view changes related to mental healthcare interventions. Even psychotherapy brings on physical change.
While the specific ingredients that make psychotherapies effective
are still under scientific investigation, the development of imaging
techniques allowed us to demonstrate that psychotherapeutic treatments
are capable of inducing long-lasting changes in brain functioning.
The wish to improve stroke recovery has prompted a greater initiative for neuroimaging, and it has branched out to many other areas where this technology can be helpful. Although the research may center on neurologic disorders such as Parkinson’s, it has potential for mental health disorders.
Along with being able to view the brain not simply in static form but actively functioning at tasks, healthcare professionals may be able to assist in impaired functioning. The “assistance” may come from non-invasive deep brain stimulation (NIBS) that modifies the brain through its potential for neuroplasticity. How might it bring about these changes?
Non-invasive brain stimulation for psychiatric disorders includes transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation, both of which have increased use in treating major depression. An overview of the results obtained for those with major depressive disorder appears to favor NIBS, but there is room for improvement.
One hypothesis as to how these stimulation techniques may work is that they affect vital brain-derived neurotropic factors, which are believed to be relevant in normal and pathologic brain functioning.
The stimulation technology features two things that mitigate its use in the broader population, it does not require surgery, and there is no need for sedation. In addition to major depression, variations of these techniques have been explored in persons with schizophrenia, OCD, and other anxiety disorders.
Since the initial work with brain disorders and behavior, brain stimulation and modification have changed. Those on the frontier of this work weren’t always viewed with enthusiasm, and ECT, although effective for some patients, is still not accepted by all.
The implementation of brain-altering electrical current has come a long way since the days of Dr. Jose Delgado, who implanted electrodes into bulls used in Spanish bullfights. After his initial efforts at controlling the animals, he used hospital patients for his work with humans. Delgado’s premise was that the device would be helpful in unmanageable patients.
Ugo Cerletti was the first to use ECT to produce controlled seizures since the belief of the time was that seizures would lead to behavioral improvement. Seizures were seen as central in treating mental health disorders. One scientist, Julius Wagner-Jauregg, won a Nobel Prize for his seizure discovery relative to a malaria drug.
A doorway to a potentially promising future for mental disorders has been revealed, but safety and efficacy are still significant factors to consider. With those concerns in mind, research in brain stimulation is ongoing and clinical trials are listed on national websites.
