University Times

Pitt doctors among first to test electronic device to ease depression

Researchers at Western Psychiatric Institute and Clinic are among the first in the nation to study whether a small implanted electronic device is a safe and effective treatment for patients with treatment-resistant depression (TRD).

If successful, the new treatment may become a unique and effective alternative to electroconvulsive therapy, now the most common treatment for TRD.

Like a pacemaker for the brain, the NeuroCybernetics Prosthesis (NCP) helps regulate nerve impulses by sending intermittent mild pulses of electricity directly to the vagus nerve. The NCP is surgically implanted in a patient's left upper chest and is connected to the vagus nerve in the neck by way of a flexible lead. Signals from the NCP travel through the lead and into the brain.

UPMC will implant the device in up to 30 patients. Each patient will be evaluated for approximately 12 weeks after getting the device.

At the end of the study period the researchers will issue their findings to the U.S. Food and Drug Administration.

Depression affects about 5 percent of the U.S. population. Women are twice as likely to suffer depression. The economic cost of depression is estimated at more than $40 billion a year.

Numerous antidepressant drugs are available to treat the disease, and most people respond to a combination of drugs and talk therapy. However, approximately 30 percent of the estimated 1.5 percent of the general population with severe, recurrent episodes of depression has a form that is resistant to conventional treatment.

Vagus nerve stimulation with the NCP system has been used safely in Europe for the treatment of epileptic seizures since 1994 and in the U.S. since 1997. A recent pilot study showed that the NCP system seemed to help nearly 50 percent of patients who had TRD.

"A new solution to treatment-resistant depression is very exciting," said Robert H. Howland, Pitt associate professor of psychiatry and principal investigator of the Pittsburgh study. "

The vagus nerve is used for several reasons. There are very few pain fibers in the nerve, which means that treatment with the NCP is relatively painless. And the vagus nerve is one of the major nerves leading directly from the brain through the neck and throughout the upper body. In an adult, the nerve averages 22 inches in length. It serves as one of the primary communication links between the organs of the body and the brain, and more than 80 percent of the electrical signals applied to the vagus nerve reach the brain. Vagus nerve stimulation appears to directly affect those parts of the brain involved in the regulation of moods.

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Yo-yo dieters show lower levels of good cholesterol

Women who repeatedly gain and lose weight, especially if they are obese, have significantly lower levels of HDL or "good" cholesterol than do women who maintain their weight.

These findings were published in the November issue of the Journal of the American College of Cardiology by researchers from four institutions conducting the Women's Ischemia Syndrome Evaluation (W.I.S.E.) study, sponsored by the National Heart, Lung and Blood Institute.

"These findings may have a great significance because 40 percent of adult women report attempts to lose weight, and many will gain it back," said Marian Olson, research associate at Pitt's Graduate School of Public Health and first author of the paper. "While obese weight cyclers tended to have the lowest HDL cholesterol levels among all weight cyclers in the study, even thinner women who repeatedly gain and lose weight showed lower HDL levels than those who maintain their weight." Low HDL cholesterol is a major risk factor for heart disease.

Cardiologists study new pacemaker therapy for congestive heart failure

Cardiologists at UPMC Health System's Cardiovascular Institute are participating in a multi-center clinical study of a new experimental treatment, called bi-ventricular pacing, for patients with congestive heart failure.

The study will evaluate a pacemaker that synchronizes the beating of the left and right ventricles of the heart. Current pacemakers only stimulate the right side of the heart.

"Currently, drugs are the only effective treatment for people with heart failure. When drugs fail, patients are placed on the heart transplant list," said Arthur Feldman, director of UPMC's Cardiovascular Institute, co-principal investigator in the national study and immediate past president of the Heart Failure Society of America. "This pacing device represents the first attempt to find a non-drug treatment alternative."

Congestive heart failure is the progressive weakening of the heart muscle and loss of its ability to efficiently pump blood. In the United States, there are some 450,000 new cases diagnosed each year.

Srinivas Murali, associate professor of medicine and director of cardiac transplantation, is co-principal investigator.

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Minimally invasive hernia surgery safe and effective

Minimally invasive surgery for giant paraesophageal hernias (PEH) has proven to be safe and effective with a minimal complication rate and good intermediate surgical results, according to a study published in the Annals of Surgery.

In a PEH, as much as one-third of the stomach herniates, or moves up, into the chest cavity through a hole in a weakened diaphragm. During minimally invasive surgery, surgeons make four or five small incisions to access the abdominal cavity. A tiny video camera and small instruments are inserted through the incisions and surgeons view the operation on a television monitor. Traditionally, repair has been performed through open surgery.

"Previous studies found that significant complications may occur if these hernias are left untreated. These complications can include gangrene of the stomach, perforation and hemorrhage," according to James Luketich, assistant professor of surgery. He also is co-director of the Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive Surgery at UPMC Health System, section head of thoracic surgery and principal investigator of the study.

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Pitt scientists ID how brain gets ready to perform

Researchers at the School of Medicine have uncovered the mechanism by which the brain prepares itself to solve a problem. The research was presented at the annual meeting of the Society for Neuroscience.

The Pitt researchers, led by Cameron Carter, associate professor of psychiatry, conducted a series of functional magnetic resonance imaging (fMRI) studies showing that the part of the brain called the dorsolateral prefrontal cortex (DLPFC) becomes active when a person is preparing for a task. The more it activates, the better that person performs a given task.

Yet, absent anticipation that a task needs to be performed, the DLPFC does not activate at all.

"This part of the brain plays a unique role in preparing us to perform a cognitive task," Carter said. "The DLPFC seems to look forward to what the brain needs to do next in order to perform the task better."

According to Carter, this research may give scientists a greater understanding of psychiatric disorders, such as schizophrenia, by identifying the pathways normal brains use to perform cognitive functions.

Other researchers involved include Angus MacDonald and Stefan Ursu, Pitt graduate students; Andy Stenger, Pitt assistant professor of radiology, and Myeong Ho Sohn and John Anderson, Carnegie Mellon.