How A Pacemaker For Brain Helped US Woman With Crippling Depression

A woman from the United States underwent surgery to have 'emotion-regulating' electrodes implanted in her brain as a resort to ease her crippling depression. Meet Emily Hollenbeck, a psychologist and educator from New York, who was ready to go to any extent to get better. When several treatments failed, she opted for Deep Brain Stimulation (DBS), which, researchers say, could eventually help many of the nearly 3 million Americans battling depression like her. The treatment has been approved for conditions such as Parkinson’s disease and epilepsy, and many doctors and patients hope it will become more widely available for depression soon.

Hollenbeck's psychologist told the Associated Press that she saw the results soon after the surgery. "The first day after surgery, she started feeling a lifting of that negative mood, of the heaviness, I remember her telling me that she was able to enjoy Vietnamese takeout for the first time in years and really taste the food. She started to decorate her home, which had been completely empty since she moved to New York,” her psychiatrist, Dr. Martijn Figee, said.

Emily Hollenbeck's Story

Hollenbeck had a difficult childhood spent in poverty and sometimes homelessness. Her psychologist told the AP that she showed signs of depression even growing up. The symptoms were exacerbated when she lost her father to suicide in 2009 when she was in college. Since then, she suffered several acute bouts of depression which often left her immobilised.

“I ended up having sort of an on-and-off pattern,” she told AP. After responding to medication for a while, she’d relapse. She also had suicidal thoughts. She was working with Teach for America when the illness hit so hard, she had to be hospitalised. A few years later, while pursuing a doctorate in Psychology, Hollenbeck lost her mother to mental illness.

She tried several types of treatment, including electroconvulsive therapy, but nothing seemed to work. That was when she decided to undergo DBS, which her psychologist had told her about. She became one of only a few hundred treated with DBS for depression.

Speaking about how she feels after the treatment, Hollenbeck told AP, “When I was depressed, I couldn’t listen to music. It sounded and felt like I was listening to radio static,” she said. “Then on a sunny day in the summer, I was walking down the street listening to a song. I just felt this buoyancy, this, ‘Oh, I want to walk more, I want to go and do things!’ And I realized I’m getting better.”

While Hollenbeck says she isn't completely cured of depression, she feels remarkable progress in her brain. “It’s not about being happy all the time,” the doctor told her. “It’s about making progress,” she told AP. Researchers are figuring out ways to study how "progress" can be measured in complex illnesses like those affecting mental health. “The stress is pretty extreme at times, but I’m able to see and remember, even on a bodily level, that I’m going to be OK. If I hadn’t had DBS, I’m pretty sure I would not be alive today," she said.

What Is DBS?

The research for Deep Brain Stimulation dates back almost two decades ago, led by neurologist Dr Helen Mayberg. After several rounds of trial and error, researchers and scientists are now pushing it as a technique to regulate mental illnesses like Parkinson's and depression.

Hollenbeck's surgeon Dr Brian Kopell placed thin metal electrodes in a region of her brain called the subcallosal cingulate cortex, which regulates emotional behaviour and is involved in feelings of sadness. The electrodes are connected by an internal wire to a device placed under the skin of her chest. This device controls the amount of electrical stimulation and delivers constant low-voltage pulses. 

In normal brains, Kopell said, electrical activity reverberates unimpeded in all areas, in a sort of dance. In depression, the activity gets stuck within the brain’s emotional circuitry. DBS seems to “unstick the circuit,” he said, allowing the brain to do what it normally would. According to a 2022 study, DBS for depression in different brains is associated with average response rates of 60%. Now, researchers are working on DBS treatments tailored to different individuals.