Neurotherapeutic Interventions in Psychiatry

5.11.2010

SPEAKER:
Darin D. Dougherty, MD, MSC, Director, Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Associate Professor of Psychiatry, Harvard Medical School (HMS)

 

MODERATOR:
Thomas Brady, MD, Director, Cardiovascular Imaging and Intervention and Director, Radiology Research, MGH; LL Robbins Professor of Radiology, HMS; Co-leader, CIMIT Cardiovascular Program

 

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Forum Abstract

The Division of Neurotherapeutics at MGH is dedicated to providing clinical care for the most treatment-resistant patients using device and/or surgical treatments. In addition, the Division is heavily involved in developing new such treatments and is internationally recognized for its efforts. These treatments include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), cortical stimulation (CS), ablative limbic system procedures such as anterior cingulotomy, and deep brain stimulation (DBS). Work within the Division has helped in obtaining HDE approval from the FDA for DBS for obsessive-compulsive disorder (OCD) and the Division currently involved in the pivotal trial for FDA approval for DBS for major depression.

 In addition to the clinical benefit that these interventions provide, they are also powerful tools for elucidating the pathophysiology of psychiatric illnesses. For example, the Division is currently conducting studies examining the effects of DBS on extinction recall and reward processing. During the DBS implantation procedure itself, they are conducting microelectrode studies intraoperatively from the nucleus accumbens while the patient performs a reward task. Members of the Division have longstanding experience in neuroimaging research (including fMRI and PET) and are using these technologies to examine the effects of these interventions on brain circuits thought to be involved in the pathophysiology of OCD and major depression. Perhaps most important, they are using neuroimaging to predict which patients are most likely to respond to these interventions. Neuroimaging could become a powerful tool for individualized care.
Lastly, the Division is collaborating with multiple institutions to further its understanding of the mechanism of DBS (they have recently received a 5 year, $10 million Conte grant shared across four institutions for this purpose). These studies are truly translational, ranging from studying the effects of neuronal stimulation in vitro, to studies in rodents, primates, and humans.

The Division’s long-term goal is to develop an independent infrastructure within the Division of Neurotherapeutics at MGH that would allow them to perform these translational studies all within its own Division. This will be crucial for developing new therapies (examples of potential new therapies include introduction of neurotransmitters or neurotrophic factors within the brain using surgically implanted cannulae and optogenetics, a process that uses gene vectors to introduce channels to specific neurons within the brain that can be activated or inhibited with specific wavelengths of light).

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