The Brain Stimulation Service is a unique specialty program offering expert consultations, treatment, and referrals for individuals with treatment resistant depression (TRD). Our mission is to better the lives of people with treatment resistant psychiatric disorders by discovering new therapeutic strategies using emerging brain stimulation and neuromodulation techniques. Currently approved treatments include vagus nerve stimulation (VNS) and new modifications of electroconvulsive therapy (ECT) that improve its safety profile.

Program Goals

	To provide expert consultation for patients with treatment resistant depression.
	To offer recommendations regarding appropriate treatment options.
	To educate individuals regarding their treatment options to help them make informed decisions.
	To provide treatment with approved brain stimulation techniques where clinically indicated.

What is Treatment Resistant Depression?

While currently available medications and psychotherapies are effective for many people with depression, unfortunately a substantial number of people do not respond. When depression is resistant to treatment is can become chronic, lasting for long periods of time in some cases. Depression can also recur, making long-term maintenance strategies very important.

What is Brain Stimulation?

Brain Stimulation represents a new discipline in psychiatry focused on the use of emerging electromagnetic means of modulating brain function to study and treat psychiatric disorders that fail to respond to medications. These techniques use magnetic or electrical fields to stimulate the circuits in the brain that underlie major psychiatric disorders. This stimulation causes the neurons to fire and release the brain's own endogenous neurotransmitters. Repeated stimulation can modulate or "reset" the firing rates of specific regions of the brain to exert lasting changes. Brain stimulation is not a replacement for medications, but it may be added onto medications to improve outcome. As with other treatments, brain stimulation has a risk of side effects that should be discussed thoroughly with your doctor before making a decision.

Approved Brain Stimulation Techniques

Vagus Nerve Stimulation (VNS): VNS was recently approved by the FDA for the long-term treatment of chronic major depression that has not responded to antidepressant treatments. VNS is performed with an electrical device like a pacemaker that is implanted in the chest. Electrical leads are connected to the vagus nerve in the neck. The vagus nerve sends impulses to the brain. VNS is indicated for the adjunctive long-term treatment of chronic (more than 2 years) or recurrent depression for patients 18 years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments. VNS is not a replacement for medications or electroconvulsive therapy (ECT), but it can be added onto other treatments for adjunctive therapy and long-term management. New York Presbyterian Hospital and the New York State Psychiatric Institute played a role in the initial clinical trials of VNS for depression. More information about VNS can be found at www.vnstherapy.com.

Electroconvulsive Therapy (ECT): ECT has been modernized substantially since it was first introduced some 70 years ago. ECT remains the most effective and rapidly acting treatment for severe treatment resistant depression and other disorders. Modifications in ECT technique, electrode placement, and dosage can dramatically affect the side effects and tolerability of the treatment. New York Presbyterian Hospital and the New York State Psychiatric Institute have long been recognized as leaders in the field of ECT research and clinical practice.

Future Directions: We are actively engaged in research with experimental forms of brain stimulation to help identify safe and effective treatments for medication resistant depression and other disorders.  Areas of research include transcranial magnetic stimulation (TMS) and magnetic seizure therapy (MST).

Clinical Services

In-depth evaluations are conducted by a team of psychiatrists with expertise in brain stimulation techniques. They are assisted by consultants from our research faculty and other medical and neurological specialists as needed. Integrating this information, we provide a comprehensive assessment, second opinion on prior treatment strategies, and recommendations regarding state-of-the-art clinical care. Where appropriate, FDA approved brain stimulation treatments may be prescribed and administered.

Clinical Staff

Sarah H. Lisanby, MD
Program Director
Associate Professor of Clinical Psychiatry

Alexandra Spron, MD

Peter Bulow, MD

Referrals

Referrals may be made by treating clinicians or patients themselves.

Contact

To receive a clinical evaluation to help you and your doctor determine whether brain stimulation might be right for you, you may contact us at 212-543-5558 or depression@columbia.edu