A surgery for depression: What is deep brain stimulation?

India has made significant progress in the area of psychosurgery. An Australian woman who had been struggling with depression for 26 years underwent her first psychiatric procedure in Mumbai’s Jaslok Hospital last month, according to The Quint. Since the Mental Healthcare Act was introduced in 2017, this is perhaps the first instance of its kind in India. Let’s take a closer look. Also read: Can smartwatches help detect Parkinson's before doctors? Deep brain stimulation surgery The American Association of Neurological Surgeons describes deep brain stimulation (DBS) as an elective surgical procedure that involves implanting electrodes in specific brain regions. Electrical impulses produced by these electrodes, sometimes known as leads, are used to regulate abnormal brain activity. The chemical imbalances in the brain that lead to various illnesses can also be corrected by electrical impulses. A programmable generator that is positioned beneath the skin in the upper chest regulates the stimulation of various brain regions. Some people with depression are given the option of DBS surgery, which involves implanting electrodes in the brain to alter the neuropathways. This procedure is offered when medication is no longer able to preserve a patient’s high quality of life. Many neurological disorders, including Parkinson’s disease, obsessive-compulsive disorder, dystonia, epilepsy, essential tremor, and depression, are treated with it. According to neurosurgeon Paresh Doshi’s statement to the Times of India, During DBS surgery, the patient is awake so that the surgeons can map responses while placing the electrodes. For 30 years, DBS has been utilised to treat neurological conditions. However, it wasn’t until the past ten years that it began to be utilised for psychiatric conditions, according to the report. Also read: Love French fries, think again. How they could leave you feeling anxious and depressed The procedure in India The new Act states that psychosurgery can only be performed following the patient’s informed agreement and the approval of a specially created state mental health board. A hospital board used to consider similar proposals in the past. The new Mental Healthcare Act’s regulations, according to Dr J Reddy of NIMHANS in Bengaluru, have been put in place to protect patients’ rights and prevent needless procedures. The psychiatrist must first determine if the patient would benefit from surgery. TOI quoted Dr Reddy as saying, “A neurosurgeon is then brought into the picture. The doctors then move the medical board which independently evaluates if the patient needs surgery.” Dr Doshi told the outlet, “Maharashtra has not only been ahead of many other states in setting up a mental health board, it has now become the first to give permission for a surgery.” “We operated on three patients with depression in the past and they are doing well. Maharashtra and Karnataka are the only states where DBS surgeries have been regularly conducted for depression in the past,” Dr Parekh Doshi, who conducted the first psychiatric surgery in the city as well as the country since the 2017 Mental Healthcare Act. Also read: Child passes out right after birth; turns out he was overdosing on tobacco through mother's vein Mumbai’s first DBS surgery for depression For the Australian patient, it took 10 months from the time she first contacted Dr Paresh Doshi to the time she underwent surgery on 28 May. The family got the reference from two Australian patients who had undergone the same surgery at Jaslok Hospital years back, according to TOI report. For 26 years, the unidentified patient has struggled with depression. According to her brother, she had tried more than 20 different antidepressants and was given at least five medications in much higher amounts than typical. She had also had cognitive behavioural therapy and ECT, both of which had been ineffective. Two Australian patients who had the same procedure at the Jaslok Hospital years earlier recommended Dr Doshi to her family. DBS is not available in Australia since it is seen as an experimental treatment for depression. According to Dr Doshi, the patient’s anxiety greatly decreased and her mood marginally improved throughout the procedure. Depression According to the American Psychiatric Association (APA), major depressive disorder, also known as depression, is a frequent and significant medical condition that has an adverse impact on one’s feelings, thoughts, and behaviour. Thankfully, it is also curable. Sadness and/or a loss of interest in previous hobbies are symptoms of depression. It can impair your ability to perform at work and at home and cause a number of mental and physical issues. According to the World Health Organization (WHO), depression affects 280 million people worldwide, making it the most prevalent mental health issue. One in 20 Indians, as per the National Mental Health Survey 2015–16, has depression.