Depression is a truly complex disorder, which in 30% of cases do not respond to treatment conventional. Neither pharmacotherapy nor psychotherapynor the transcranial magnetic stimulation (used to treat OCD) appear to offer lasting relief to those who become trapped in the more resistant states of the disease. And although at first they can be ‘given up as lost’, the Argentine psychiatrist Salvador Guinjoan He is already working on another avenue of treatment.
The idea. The psychiatrist, researcher Laureate Institute for Brain Research from Oklahoma, is working on an alternative that uses more physics than psychiatry for these patients who a priori had no other type of solution. This is based on the low intensity focused ultrasound, what is known as LIFU (Low-Intensity Focused Ultrasound).
During the recent Conference on Updates on Neuromodulation held in Seville by the Spanish Society of Clinical Psychiatry, Guinjoan explained that the objective is quite ambitious: to modify the electrical activity of the brain circuits involved in psychiatric symptoms without the need to open the skull or implant an electrode as he explained. in an interview to El País.
What is LIFU. This technology uses mechanical energy instead of electrical or chemical energy. Its transducer generates ultrasonic waves that are capable of passing through the skull and concentrating the energy at a very specific point in the brain, subtly modulating the mechanosensitive ion channels of the neurons. In practice, this alters neural communication in regions that are involved in emotion, motivation, or decision-making.
But the important thing in this case is that unlike traditional deep stimulation (DBS), which requires surgery and permanent implants, LIFU allows completely reversible interventions with high anatomical precision. According to Guinjoan, the method opens the possibility of observing, for the first time, causal relationships between a specific brain circuit and a clinical symptom: “If modifying a circuit changes the symptom, we can begin to understand the cause,” he points out.
The bibliography supports it in these cases, since previous research, such as those carried out in the Massachusetts General Hospital and published in Nature Neuroscience (2024), had already shown how LIFU can influence deep regions such as the amygdala or thalamus without visible tissue damage. Now, the challenge is to transfer that precision to the psychiatric field.
Key points. Guinjoan and his team focus their trials on two key markers of resistant depression: anhedonia (inability to experience pleasure) and the persistence of negative thoughts. Both phenomena seem to be related to connection circuits between the prefrontal cortex and the basal ganglia. And it is precisely in this circuit where the psychiatrist wants to intervene with LIFU.
The researcher suggests that modulating the subcircuits that connect the prefrontal cortex and the basal ganglia with ultrasound can alleviate these characteristic symptoms without resorting to surgical interventions and perhaps without more medication in the future. And although at the moment there is still a long way to go, pilot studies in the United States point to sustained symptomatic improvements after several sessions, with mild side effects such as temporary headaches.
The ethics. The ability to literally reprogram the brain without invading it opens up questions that go beyond medicine. Guinjoan agrees with neuroscientist Rafael Yuste, promoter of the neurorightsin which it is urgent to regulate the non-therapeutic use of these technologies. Although the border between treating a disease and enhancing mental performance is increasingly blurred.
Unlike other home neuromodulation tools, such as transcranial electrical stimulation (tDCS) devices that They are already sold for personal useLIFU requires high-precision neuronavigators and a specialized clinical environment. Guinjoan does not believe that it will become a domestic technology, but he does imagine a future where each patient receives a personalized neuromodulation treatment, adjusted to their specific neural map.
The future. If ongoing trials confirm efficacy, focused ultrasound could be incorporated in the next decade into the arsenal we have in the treatment of resistant depression, anxiety or even schizophrenia. All this without having to enter an operating room. Something that could also represent a new leap in psychiatry as we know it and a paradigm shift in the therapeutic approach to this type of pathology.
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