Commenting on the presentation, Dr. J. John Mann, chief of the department of neuroscience at the New York State Psychiatric Institute, said this approach holds tremendous potential for improving the treatment of severe depression because it can potentially spare patients from the adverse effects—especially memory loss—that infrequently accompany conventional ECT.
“Over the past 10–15 years, we've been able to map in detail the parts of the brain affected by depression, and identify the [anatomical sites] responsible for the specific components of what we call depression,” Dr. Mann said. “The parts of the brain adversely affected by ECT and responsible for memory loss are not essentially involved in the depression syndrome, and therefore, they should be spared.”
If focally induced seizures that do not result in generalized motor convulsions are shown to be clinically effective, there would be other benefits as well. In routine ECT, muscle blocking agents are used to dampen the motor convulsion, protecting patients from injury. The greatest risk to ECT patients actually comes from the anesthetic agents used than from the ECT treatment itself, and any reduction in anesthetic would make ECT considerably safer. According to Dr. Berman, there's also a possibility that a protocol like FEAST might be used to induce focal neurogenesis, an objective that's been something of a Holy Grail for generations of research neurologists.
“We don't really know how neurons are induced to divide. But we know that ECT stimulates robust neurogenesis in the hippocampus and there is now some evidence for neurogenesis in other parts of the cortex as well,” he said.
Dr. Berman acknowledged, however, that routine clinical applications of FEAST—or any of the other new, experimental forms of brain stimulation—are still several years in the offing.
“Before patients will be able to have access to this, it will have to be presented to and approved by the [Food and Drug Administration]. We need to demonstrate that it really is an improvement over standard ECT.”