There are cases of depressions and schizophrenia (the more resistant of all, those who after years and years have not experienced no improvement, neither with drugs nor with therapy) that can be operated in an operating room. He Hospital of Santa Creu i Sant Pau, in Barcelona, is the single health center not only from Catalonia and Spain, but from all over southern Europe, that carries out these interventions, which consist of the placement of electrodes deep in the brain. are operations minimally invasive: the next day the patient is at home. In the whole world, there is only five hospitals that operate depression. This surgery, along with the use of new drugs as the esketamine, It has already shown benefits against resistant depressions. A 5% of the Spanish population (about 2,350,000 citizens) suffer from depression. Of these, around a third (about 775,000) have resistant depression.
The intervention, minimally invasive, consists of placing electrodes in deep areas of the brain
After 14 years of experience and several clinical trials, a article to be published soon in ‘The Journal of Clinical Psychiatry’ demonstrates the “Very good results” of surgeries performed by Sant Pau in cases of deep depression: approximately between 60% and 65% from the patients improve “significantly” Your symptoms at five years old. In a 40% of the sick, depression has fully remitted. “And over time this [la mejoría] goes to more why this therapy changes brain circuitry,” points out the neurosurgeon from Sant Pau Juan Aibar.
A multidisciplinary team de Sant Pau (psychiatrists, neuropsychologists, psychologists, neurosurgeons, neurologists and anesthetists) operate the depressions refractory to drugs more “extremely resistant”, from 2009. In 2016 he started the first clinical trial with schizophrenia and this year will begin the second with this disorder.
In 40% of patients, chronic depression remits completely
However, the benefits of these surgical interventions are more tested with depressions. “The neuromodulation of psychiatric disorders consists of the electrode implantation in certain places in the brain disease-related,” explains Aibar. The obsessive compulsive disorder (ocd) is another of those that are also beginning to operate, but in other centers.
the first rehearsal
Sant Pau made in 2009 the first european clinical trial on the surgical treatment of resistant Depression, which included eight patients. In 2014, the second started. Throughout these 14 years, the hospital has operated on a total of 18 people and all this experience has made him a expertise center in this ambit.
The operation is not performed at a general level: only to those patients who have not responded to other therapies for years
“We cannot say that it is an operation that is carried out at a general level: it is not approved by the Food and Drug Administration (FDA) of the USA nor by the European Medicines Agency (EMA). But it is recognized that certain selected patients in specialized centers they can be benefit of this therapy”, defends this neurosurgeon.
Operating depression is the “last therapeutic link”: Only those people who, for years, have They have not responded to anything else. The experience of Sant Pau has led him to discover what are the brain neurons involved in the improvement of the disease, something that allows doctors refine more where to place the electrodes in each patient.
The good results obtained (always long-term, sometimes up to eight or nine years later) lead Aibar to think that, little by little, The number of patients who can be operated on for depression will increase (although they will still be a minimum percentage). “Those people who cannot be helped by their GP nor his psychiatrist they could be derivatives to a center with these alternatives”, aim. Believe that the future happens because, in every state, is one or two centers where these interventions can be made.
As the director of the Sant Pau Psychiatry Service explains, Narcis Cardoner, classical psychiatry is “in evolution”. For example, there are new drugs which are also used in resistant depressions. One of them are the anti-inflammatories, since there are some depressions that are related to the intestinal microbiota (the bacteria of the digestive system), as explained Amanda Rodriguez, psychiatrist at the Resilient Depression Program of the Vall d’Hebron Hospital from Barcelona.
Psychiatrists already use drugs such as anti-inflammatories to treat some depressions
“For the first time in many years, there are beginning to be publications about the use of anti-inflammatories to treat depressions related to the inflammatory system, something that has to do with the immunological alterations. Here it would be more useful anti-inflammatories than antidepressants,” Rodríguez says. Even so, she still is being investigated about.
The drug that has proven to be very successful in the treatment of resistant depression is esketamine, an antidepressant that acts on receptors (targets) in the brain for a substance called NMDA and that it is faster than traditional treatments. Thus, it does not act on the serotonin, a hormone on which, for the most part, has been focusing for decades psychiatry to treat depression. esketamine takes effect a week compared to traditional drugs, which take about a month.
“We are now incorporating other models [para tratarla]”, says Cardoner. Dr. Rodríguez talks about a “personalization of psychiatry”, since, for example in the case of depression, there are many types and that is why they cannot all be treated in the same way. Psychiatrists are also investigating the use of psychedelics such as psilocybin (always administered under medical control and supervision) to treat resistant depression. The US is expected approve it soon.
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