Deep Brain Stimulation as Depression Treatment 273
Neopallium writes "Medtronic, today announced its intentions to pursue a major clinical trial of the company's deep brain stimulation (DBS) technology in the treatment of severe and intractable depression, a disabling form of the psychiatric disorder affecting millions of people worldwide. "While not a cure, DBS has allowed these patients to return to much more functional and happy lives," said Dr. Rezai, who represented an international working group of physicians that has been studying the application of DBS therapy in the treatment of intractable depression and OCD in collaboration with Medtronic."
There are a few loose ends.... (Score:4, Informative)
1. Reading the story and the paper doesn't tell you what Deep Brain Stimulation actually is. What'd you think? Phoebe Buffet was going to climb on and reach deep into your skull and start the massage?
Fortunately, someone put good wiki material for those of you who didn't already know what it is. To save you the reading, it's a "pacemaker" in your brain.
2. Shock treatment (as in for the loonies) has been making a comeback for the previous decade or so as an attempt to rebalance those who are severely depressed or those who are Bipolor (or Manic-Depressive) but spend more time on the down side than the up side.
3. Regardless of the treatment, many seriously believe "fixing" this, particularly the down or depressed side will decrease or neutralize the creative side of those who are exceptionally creative. I know many friends who are careful about the medications they take and insist upon some trial & error not just on the effectiveness axis, but the suppression of creativity. If the latter is lost or decreased, they'd rather do without medication (with or without their physican's knowledge).
4. If this sounds familiar to you or you think it's a good idea for a book, think of it as a first cousin to one of Ray Bradbury's (existing) books.
Re:The war on drugs...and solenoids. (Score:5, Informative)
Spider Robinson may have derived his stories from Niven's originals -- legitimately, I believe, as the "wirehead" meme now seems to be as much a part of SF as FTL has been since the Golden Age. Spider wrote it into "Lifeship" and one other short story involving deprogramming of a wirehead. (/soapbox)
Re:There are a few loose ends.... (Score:5, Informative)
Before I start, both I and my wife suffer from chronic depression (and I'm bipolar). We both lead perfectly normal and happy lives - thanks to medication. So I know what I'm talking about.
> 2. Shock treatment (as in for the loonies)
Oh, thank you very much! I haven't had this, but my wife was so desparate that she did. I can't say whether it cured her (I suspect the medication has much more to do with it), but I *can* say that it is a brutal approach. I refused because I was afraid that it would damage my mind (which is a very good one - polymath). It tore her mind to bits! For months after the sessions she was confused, had massive memory loss (and those memories are gone for good) and suffered - possibly more than the depression itself. I think that one could compare it to resetting a computer by throwing a bucket of water over it. Quite possibly, its only effect is to press RESET on the brain and let it rebuild from there.
> but spend more time on the down side
Actually, the "up" side is even worse. You can do serious damage to yourself and those around you, mentally, spiritually, financially and even physically. At least when you're "down" you tend to stay put. Not that it's much fun.
> 3. Regardless of the treatment, many seriously believe "fixing" this, particularly the down or
> depressed side will decrease or neutralize the creative side of those who are exceptionally
> creative.
There is something in this, but it misses the point. People who want to mitigate the effects of the medication for any reason don't have *severe* depression. If you do, you will do ANYTHING to make it stop... and I mean *ANYTHING*. Why do you think sufferers kill themselves? In a way, I'm lucky because my disease started at an early age and built to a crescendo by the time I was 30. If I (or, I suspect, anyone) suffered the full effects in one go I would have looked for the very first way to kill myself - immediately.
I do suffer some performance hit from the medication, but it's worth it. I once tried to get a boost for an important problem by stopping my medication. Never again!
If you're a sufferer, don't worry about this. It really is fairly minimal and, as I said, very well worth it. Look at it this way; if you don't have to spend most of your mental energy fighting it, you're more productive anyway and much happier as well. In the course of my treatment, they concentrated on mitigating the symptoms, then hunting round for the correct drug and dosage for everyday life. It works very well.
Finally, don't be ashamed. I know that there's a lot of stigma attached to depression and OCD but were you ashamed when you had a cold? Of course not! And it's the same thing - a disease. And it can be treated. If you have it, get help NOW! There is no need to suffer. It will take time and patience, but it can work.
And, finally, finally: Remember you're not alone. Many others know how you feel (me, for example) and love and understanding can go a *long* way (soppy, but true). Where do you think my wife and I met? Yup - the loony bin (*I* am allowed to say it
Demystifying depression (Score:3, Informative)
In short, try not to think as depression as something simply psychological, but as a physical illness caused by chronic abuse of the brain. Giving it a chance to rest is the first step towards recovery.
Re:Unexpected side-effects (Score:5, Informative)
Mr. Coward, you are correct. I had depression for a while. I learned quite a bit about what it is and how it works. First, you have so-called normal people. They may get sad and say they are depressed. These bouts may last days, for example, after a traumatic event such as the death of a spouse or parent. That is not real depression. Then there are people like me who were trapped in a bad situation for a long period of time and just couldn't deal with the pressure. That's just a worse case of the first scenario. Finally, there are the truly depressed people. They have a chemical or other imbalance in their brains that causes depression for no reason. Everything could be going well in life, and they just start crying, get into a funk, and can't get out of it. They may snap out of it and be okay for a while. Depression moves in cycles.
I read an article in one of the IEEE magazines about two months ago on exactly this topic. Essentially, physicians implant an electrode in the patients brain that stimulates the area responsible for depression, so it helps avoid those slumps. It has a similar function to SSRIs, aka Prozac and other drugs that mess around with serotonin, but with few if any side effects. Similar to a pacemaker, a surgeon can implant an electrode and small battery into the patient's head that requires infrequent maintenance (every few years). If this works long-term, I think it will be a very good thing. Many otherwise productive members of society are unable to function at times because of depression. If we can remove that depression, we are stronger as a society, an economy, and most importantly, as a family. I know what depression can do to a family. It isn't pretty.
Maybe Lincoln was depressed, maybe he was not. I am not an expert on that topic so I won't debate it. However, assuming he was, I think he would have been just as effective without the depression. Those same thoughts and tendancies in his brain would still be there, but he would have been clearer and more rational (not that he was or wasn't already, just more so). I know from experience that the times I was on the up part of my depression cycle I was clearer and more rational, but I still had the same thoughts. I just dealt with them better.
Re:There are a few loose ends.... (Score:3, Informative)
In this case, a probe was lowered into the anterior cingulate region of the cerebral cortex (close to the midline, in front of the ears, pretty close to the middle of the cranium). The probe has 2 contacts. They alternately stimulate with electrical pulses at 125 Hz. This rate of stimulation keeps a damper on activity in the region in which it is placed. For example, it is used to calm activity in Parkinson's patients. It is NOT a pacemaker, it is a shut-off switch. The anterior cingulate is hyperactive in some depressed patients.
2. Shock treatment (as in for the loonies) has been making a comeback for the previous decade or so as an attempt to rebalance those who are severely depressed or those who are Bipolor (or Manic-Depressive) but spend more time on the down side than the up side.
Patients who will not respond to pharmacological treatment can pose huge risks to themselves or others (suicide, mainly). ECT helps some of those. Many think DBS will be a LOT better. Including me.
3. Regardless of the treatment, many seriously believe "fixing" this, particularly the down or depressed side will decrease or neutralize the creative side of those who are exceptionally creative.
The people in the study were willing to let neurosurgeons do experimental brain surgery in which a 2-3 mm wide probe is lowered 10-12 cm into the brain, with a possible side effect of death. Of course, these procedures are now reasonably common in Parkinson's treatment, so the risks are low, but still - experimental brain surgery!!! The patients want to live without the fog of depression daunting their every motivation.
Obviously, if you are not so negatively affected you want someone to do brain surgery to try to fix it, you have a choice. You can always refuse treatment.
Also, one other thing about DBS, is that you can turn the stimulator off, and your brain is largely intact as it was when the probe was first placed. ie: it is reversible. In these studies, they alternately turned the probes off and on, and people went from full-on depression to reasonably normal in minutes.
There are HUGE numbers of patients with general depression, bipolar, or schizophrenia, and a large number of them do not respond well to conventional pharmacological treatment. We're talking roughly 13-14% of all people over 40 have been diagnosed by a psychiatrist with one of these psychoaffective disorders. Now, DBS offers SOME hope (small hope at this time) to some of the depressed patients who are severely affected and are not rendered reasonably functional with antidepressants of any kind. Given the safety and efficacy record of DBS in treating Parkinson's syndrome, it seems a very good course to investigate.
Re:ECT 2.0 (Score:2, Informative)
ECT is an effective treatment and is taken quite seriously.
Depression is Real (Score:5, Informative)
This chronic condition is very serious, it is the number one cause of suicide today. Chronic depression contributes to a whole slew of self-destructive behaviors and is a major contributing factor in alcoholisim, drug abuse, child neglect, and other very serious social ills.
If life seems dull or you feel trapped inside of a bubble, if you can't find happiness when others around you do, or if you just never have energy, please see a professional (start with your doctor if you do not want to see a "shrink") to see if they can help you break out of the cycle. If you even think you may be depressed, it is time to see someone. If you think of killing yourself to escape it all, please drop everything and make the call right now.
Re:There are a few loose ends.... (Score:4, Informative)
First off, deep brain stimulation is not for the feint of heart. They permanently implant an electrode deep in the middle of your head. Actually, two of them. One on each side. This *is* brain surgery. Screwing up is a Big Deal, and, generally, brain surgery has a risk of complication measured at the 5-10 percent level. Then, in addition to these electrodes in your skull, there are wires which come out under your skin and route down to your chest to a permanently implanted stimulator. Actually, two of them. One on each side. This level of surgery is not something to be taken lightly. The target patient population is not people who feel a little down all the time; these are clinically depressed patients who spend the entire day sitting around doing nothing. Their lives are seriously impacted, just as seriously as someone who had a debillitating major physical ailment such as emphysima, heart disease, or a degenerative bone disease.
Which brings me to the point of this posting, to comment on item 3 of the parent: many seriously believe "fixing" this, particularly the down or depressed side will decrease or neutralize the creative side of those who are exceptionally creative. The patients that this treatment is intended for are so depressed that they have no creative side. They are paralyzed by their depression. They do not function in society. They are barely able to nourish themselves, and, in some cases, require hospitalization or other form of daily care. The parent poster's assertion about this particular treatment is bunk. Brain surgery is not for people who feel down but are able to live halfway decent lives; Brain surgery is for people who are seriously broken. At this meeting, I saw videotapes of patients in the pre-clinical trials, and these are people who are before treatment so fogged by depression that they communicate in single word responses; they often miss appointments with their doctors because they cannot bring themselves to leave the house; they are deeply affected by their condition.
Please draw your own conclusions about the effectiveness of the treatment by inference from Medtronic's pushing this forward to clinical testing. I, for one, am glad to see it advance.
Re:Unexpected side-effects (Score:3, Informative)
Go down to your local library and see how many famous authors, artists, and performers committed suicide.
there's a strong link between accomplishment and "not normal".
Here's a partial list of famous suicides http://en.wikipedia.org/wiki/List_of_famous_suicid es [wikipedia.org]
Or check out Buzz Aldrin's story ... http://www.horatioalger.com/members/member_info.cf m?memberid=ald05 [horatioalger.com]
And then you have those who self-medicated with alcohol, like write Jack Kerouac, and ended up dying of a stomach haemorhage, or those who turned to drugs, like Sir Arthur Conan Doyle and Ernest Hemmingway:
Re:Unexpected side-effects (Score:3, Informative)
There *are* more crazy people on the streets than in previous generations. In the bad old days, the insane were simply warehoused in asylums, or family kept them locked up. Google for "Bedlam" for a description of the worst of these. People really where kept in baskets, hence the term "Basket Case." Then in the 50's, new treatments and drugs actually let some people be cured. The better asylums became like hosiptals, but still there were the incurable cases. Then, in the 70's and 80's, due to state cost cutting, these places were shut down and everyone in them just released. In one case, the patients where simply given a one-way ticket to another state, and a few dollars in spending money.
So, no, it wasn't always the case that there were as many homeless crazy people as there are today.