Treatment-resistant Depression Treated by MR-guided Focused Ultrasound

The Yonsei University Severance Hospital and the Hanyang University Myongji Hospital announced on Sep. 22 that their join research team conducted MR-guided focused ultrasound (MRgFUS) on four treatment-resistant depression patients and the patients’ symptoms have been relieved for over a year without significant complications.

At present, surgical treatment methods such as resection and brain nerve stimulation are used in handling treatment-resistant depression. However, those have been limitedly used due to side effects and long convalescence periods.

The research team applied MRgFUS to the four patients treated at the Severance Hospital from 2015 to 2018, during which combined drugs and electroconvulsive therapy failed to relieve their symptoms. The team used Insightec’s ExAblate Neuro in conducting bilateral anterior capsulotomy for resecting brain circuits related to depression and obsession.

The team used approximately 1,000 ultrasonic generators to focus ultrasonic waves on the anterior limb of internal capsule, which causes depression in the brain. The 650 kHz waves incised the capsule after reaching the target site without wave energy loss. The error range was maintained at less than 1 mm by real-time observation.

The MRgFUS-based capsulotomy was successful for each patient, and they returned to their everyday lives the very next day. HAM-D and BDI as objective and subjective depression tests were conducted a week, a month, six months and 12 months after the treatment. In addition, neurological, neuropsychological and MRI examinations were carried out for up to 12 months after the treatment.

In one year, the four patients’ HAM-D score fell 83 percent and BDI score fell 61.2 percent, marking the world’s first successful treatment of treatment-resistant depression. The treatment entailed neither physical, neurological and psychological complications nor any clinically significant cognitive degeneration.

The team’s work was supported by a U.S. research foundation and recently published in the Bipolar Disorders (IF 5.41) journal.