Deep Brain Stimulation as Depression Treatment

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."

Comments

Stimulating

[Nefarious Wheel]

Now if I could just get some Deep Brain Coffee into me...

Re:Stimulating

[Ohreally_factor]

I wish it was as simple as that. It would sure beat what I have to do now, which is sprinkle a layer of espresso-grind coffee into my shoes, score the bottoms of my feet with a razor blade, and then tie my shoelaces really tight, so as not to leave a trail of blood after me.

I think for what you're proposing, you'd need to attach some sort of reservoir for hot water on top of ones head, with a french press type plunger to force the caffeine past the blood/brain barrier.

Unexpected side-effects

[tomhudson]

This could have some rather unexpected negative side-effects. For example, Lincoln was prone to depression - if he had been less melancholic, perhaps he wouldn't have spent so much time brooding over the negative consequences of slavery to the union. Similarly, this could spell the end to a lot of literature ...

How depressing ...

Re:Unexpected side-effects

[0racle]

How depressing ...
They can fix that now.

Re:Unexpected side-effects

[ectospasm]

You've got to remember that this will probably be used (at least at first) as an alternative treatment of major depression for when traditional (chemical) treatments do not work. It will most likely be used when the illness is debilitating, where the sufferer cannot function. Creating works of art (or performing any task which requires intense concentration) in a depressed state implies that there's a modicum of function. I know of people that cannot even put a single sentence together when they're most depressed.

As someone with bipolar disorder, I welcome any further additions to the repertoire of weapons we have against serious depression. I just hope no one in the trials commits suicide, a common occurrance of people who are just beginning to have their depression lifted.

Re:Unexpected side-effects

[BiggerIsBetter]

I just hope no one in the trials commits suicide, a common occurrance of people who are just beginning to have their depression lifted.

That's an interesting turn of events. You feel too depressed to do anything, then you start to come out of it. You still feel really down, but have the motivation to not want to feel like that anymore... yet can't imagine a lasting brighter future without coming back down again.

So what's the obvious solution when you don't want to live that way, and don't believe you have an alternative? You make a choice to stop living. It seems very reasonable at the time (been close a few times myself).

Re:Unexpected side-effects

[pipingguy]

Is there some kind of well-rounded, adequately-functioning, happy-with-life mediocre model that we all should be striving towards becoming?

I'd like to know what that ideal is and who defines it.

Sure, there *are* rambling homeless people, depressed people and confused people out there, but hasn't this always been the case? Or is the general consensus that it happens more often now and needs treatment?

I've known quite a few people that might be considered "a bit off", but as long as they are not hurting others, where's the harm in treating them as eccentrics or oddballs and just accepting them for how they are? Or does everyone have to "fit in" these days? Honest questions.

Re:Unexpected side-effects

[The Creator]

They can fix that now.

How depressing...

Re:Unexpected side-effects

[Ohreally_factor]

Sure, there *are* rambling homeless people, depressed people and confused people out there, but hasn't this always been the case? Or is the general consensus that it happens more often now and needs treatment?

Your ignorance about the suffering of the mentally ill is quite charming. You might as well as, "Why don't the clinically depressed just cheer up?" Someone undergoing a major and debilitating depression isn't "a bit off" nor are they merely eccentric oddballs.

I'm sorry if this is a bit harsh; I believe you are sincere and that your questions, as you say, are honest. However, if you are honestly curious about mental illness, you might want to get a college textbook on abnormal psychology and read up on it. You are not going to get much light shone on your ignorance in the comments section of slashdot.

Re:Unexpected side-effects

[The Snowman]

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:Unexpected side-effects

[The Snowman]

For crying out loud, call a crisis hotline or a friend next time you feel like harming yourself. You're no good to us unless you're here alive and well.

Obviously you've never been in a situation like this. There are times when depression can cloud rational thought and even though you may normally be the type of person that would never harm yourself or commit suicide, you do. It just takes a second or two, a bad snap judgment, and you do something you cannot take back.

Re:Unexpected side-effects

[deuterium]

I've actually found that when I'm depressed, my mind is useless. I can't keep a thought in my head, or even comprehend the environment around me. My senses are fuzzy and I feel like a robot. The world actually appears darker and fuzzier. Far from being creative and intelligent, I become blank and mindless. All motivation and drive are gone. I felt like I was dying. I was barely able to keep up with my job when I was depressed, and projects were pretty simple and slow back then. I'd never be able to tackle the projects I'm doing now if I were depressed.
As far as emotions, though I did experience deeper emotions during the early phases of my depressions, they were all sadness. The sadness perpetuates itself, like a deepening groove on a record, so that nothing else gets played. All connections to prior emotions wither, and they become only an idea. You forget what it was ever like to feel differently, and lose hope that you ever will.
Depression is so insidious, too. You can't point to a day when it occurs. It's like the slow buildup of dust on the TV screen, fading out the vibrancy. When it's finally removed, the world stands out in vivid contrast to the dimness. It always amazes me when that happens.

Re:Unexpected side-effects

[wazzzup]

It's not about fitting in or creating a socially acceptable human being through chemistry. It's about relief from the prison of your mind.

As someone that suffers from bouts of major depression and obsessive-compulsive disorder (OCD), if the treatment leaves me in a state of being "a bit off" but in a state where I can function in day-to-day society - that's okay.

Without treatment, I'm prone to lie in bed all day barely able to speak (the depression) while my mind (figureatively) straps me in front of an IMAX screen and makes me visualize horrible things like blowing my brains out over and over again, throwing my son off a cliff, being gang-raped and other lovely sunny-day thoughts (the O in OCD). Obsessive thoughts are completely unwanted (they don't indicate some subconcious desire) thus feeding the depression which, in turn, makes it harder to block the obsessive thoughts. In my case, I wasn't hurting others (except my family who had to watch me go through those episodes) but I was hurting myself.

While I don't think we should strive for a Stepford Wives kind of norm through medication, the medication is a godsend - not an Orwellian mind-control tactic. While you or someone else may think "so they're odd - leave them alone, it's who they are" it's *not* who they are. Who they are has been dominated and replaced by the condition/disease. I completely understand why someone that has not experienced mental illness might see things in the manner you describe. In fact, most people with mental illness won't tell thier friends or peers about thier condition because of the social stigma that mental illness carries.

With treatment, sure there are days I'm "a bit off" but that's okay - no one's the wiser.

I guess what I'm trying to say is that, while "oddballs and eccentrics" might not be hurting anyone, they may, in fact, be hurting intensely within - wishing they could rid themselves of the oddness and eccentricity and become the person they really are. The oddness is just a small part of what surfaces to the outside world. That's not to say that all oddballs and eccentrics are mentally ill either and that's truly just who they are.

In regards to wondering whether these conditions are more prevalent than they were in the past - yes, based upon my personal research on the topic.

I hope my personal experience may have answered some of your questions.

It would work for me

[Mrs. Grundy]

Well...if my brain is where my wife says it is, I can see this working quite well.

There are a few loose ends....

[70Bang]

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:There are a few loose ends....

[Cicero382]

Right! The glib tone of this post annoys me; I can't let it go by without comment.

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 :) 15 years now (happy sigh).

Re:There are a few loose ends....

[Czar the Bizarre]

Just have to let everyone know, I also met my partner in the 'Psych Ward' of a local hospital.

It certainly helps when you have someone around who understands why you feel the way you do at times. Although, the reverse is also true if you both forget to take your meds at the same time.... hehe, nasty.

Anyways, she has just given birth to our first child together (its a girl).

Hopefully, she wont suffer the same problems as her parents, but if she does... well hopefully we have the understanding to help her overcome some of the issues, or at least support her during the harder times.

Re:There are a few loose ends....

[pz]

IIANSDBS (I Am A Neuroscientist Studying Deep Brain Stimulation), and I attended one of the recent workshops that Medtronic had on this very subject where they brought together all of the physicians working on their pre-clinical trial of these devices. It was incredibly cool. Despite my having worked in the field for 6 years now, deep brain stimulation continues to astound me. The meeting covered exactly what you would think it would cover (and no, I'm not going to reveal any trade secrets or violate any NDAs): patient case studies, general results where such conclusions could be drawn, trends and statistics where available.

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:The war on drugs...and solenoids.

[Nefarious Wheel]

Larry Niven and Spider Robinson both explored the social aspects of this subject pretty thoroughly in SF literature. Ringworld Engineers comes to mind, when Louis Wu undergoes a euphoria/depression addiction cycle to a "TASP" (presumably an acronym for There Ain't Such Pleasure, a variation on TANJ used as an expletive throught his books) and a "DROUD" (no idea as to word origin).

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)

The Original Clockwork Orange

[Baldrson]

Anthony Burgess, author of the book "A Clockwork Orange" was the artist in residence while I was in the undergraduate program at the Iowa City Writer's Workshop back in 1974. I think he based his book on the work of Jose M.R. Delgado, M.D. published under the book with the damn spooky title: "Physical Control of the Mind: Toward a Psychocivilized Society".

I managed to get a copy of the book finally, and discovered wonderful passages such as the following on page 115:

ESB [electrical stimulation of the brain -- JAB] may evoke more elaborate responses. For example, in one of our patients, electrical stimulation of the rostral part of the internal capsule produced head turning and slow displacement of the body to either side with a well-oriented and apparently normal sequence, as if the patient were looking for something. This stimulation was repeated six times on two different days with comparable results. The interesting fact was that the patient considered the evoked activity spontaneous and always offered a reasonable explanation for it. When asked, "What are you doing?" the answers were, "I am looking for my slippers," "I heard a noise," "I am restless," and "I was looking under the bed." In this case it was difficult to ascertain whether the stimulation had evoked a movement which the patient tried to justify, or if an hallucination had been elicited which subsequently induced the patient to move and to explore the surroundings.

This passage is eerily reminiscent of a passage from Richard Dawkins' "The Extended Phenotype" chapter titled "Host Phenotypes of Parasite Genes":

"Many fascinating examples of parasites manipulating the behavior of their hosts can be given. For nematomorph larvae, who need to break out of their insect hosts and get into water where they live as adults, '...a major difficulty in the parasite's life is the return to water. It is, therefore, of particular interest that the parasite appears to affect the behavior of its host, and "encourages" it to return to water. The mechanism by which this is achieved is obscure, but there are sufficient isolated reports to certify that the parasite does influence its host, and often suicidally for the host... One of the more dramatic reports describes an infected bee flying over a pool and, when about six feet over it, diving straight into the water. Immediately on impact the gordian worm burst out and swam into the water, the maimed bee being left to die' (Croll 1966)."

possible spam

[William Robinson]

Dear Sir,

Our records indicate that you had been modded as Troll continuously for last 6 months on slashdot. We understand how depressing this can be.

We can offer you Deep Brain Stmulation to fix the depression and additional free package of Dumb Brain Simulation, to get +5Funny.

Warm regards

Re:I'm a safety guru!!!

[suv4x4]

Sorry replied to a wrong article, I'm recovering from a shock therapy.

Demystifying depression

[Cultural Sublimation]

On the subject of burnout and depression, you might also want to check a wikibook on the subject: Demystifying Depression. It takes a very mechanicist view on the problem, but the advice therein contained might be of help to those suffering from depression (it helped me, your mileage may vary of course).

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.

Dear Medtronic

[gone.fishing]

I have a teenager that I would like to voulinteer for your trials. I have only one condition, please equip the device with a remote that I can control.

Depression is Real

[gone.fishing]

Depression is a real condition. Being "depressed" is not the same as suffering from depression. When you are sad and you know you will get over it that is being depressed and is part of the normal human condition. Depression on the other hand is a long dark tunnel, you can not see the light at the end of the tunnel and you hold out no hope that things will get better. It is not a feeling most people would consider normal although people who suffer from it accept it as a normal part of their lives (that is why so many fail to seek help).

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.