Posted by pseudoname on April 2, 2006, at 12:06:30
There's a long article about deep brain stimulation for treatment-resistant depression in today's New York Times Magazine: http://www.nytimes.com/2006/04/02/magazine/02depression.html
It features a 41-year-old TRD woman named Deanna Cole-Benjamin, whose depression was “resistant to every class of antidepressant, numerous combinations of antidepressants and anti-anxiety drugs, intensive psychotherapy and about a hundred [!!] sessions of electroconvulsive therapy. Patients who have failed that many treatments usually don't emerge from their depressions.”
From that cheery note it goes on to describe an experimental procedure “called deep brain stimulation, or D.B.S., which is used to treat Parkinson's. It involves planting electrodes in a region near the center of the brain called Area 25 and sending in a steady stream of low voltage from a pacemaker in the chest.” (Different from vagus nerve stimulation, which zaps nerves in the neck.)
“As it turned out, 8 of the 12 patients he operated on, including Deanna, felt their depressions lift while suffering minimal side effects — an incredible rate of effectiveness in patients so immovably depressed. Nor did they just vaguely recover. Their scores on the Hamilton depression scale, a standard used to measure the severity of depression, fell from the soul-deadening high 20's to the single digits — essentially normal.”
The article talks about how neurologist Helen Mayberg and neurosurgeon Andres Lozano adapted the technique from Parkinsonism treatment, where over 30,000 people have had the surgery, although targeting a different area.
“The D.B.S. operation involves an intrusion that is delicate but brutal. The patients are kept awake so they can describe any changes, and the only drug administered is a local anesthetic. The surgical team shaves much of the patient's head and attaches to the skull, with four screws drilled through skin into bone, the stereotactic frame that will hold the head steady against the operating table and serve as a navigational aid. Mounting the frame takes only about 10 minutes.” Then they drill a hole in the top of the patient's skull and thread a guide tube down to Area 25.
In Deanna's case, Mayberg [who was running the procedure], wasn't going to tell her when the device was activated. When they switched it on, Deanna said, “It's very strange. I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.”
Then they shut it off and Deanna said, “God, it's just so odd. You just went away again. I guess it wasn't really anything.”
“It was subtle like a brick,” Mayberg said. On, she felt emotionally connected to people; off, she was severely depressed as usual.
After Deanna went home (with it on), “Not all was light and flowers. On a purely biological level, the improvement made by D.B.S. sometimes amplified the side effects of the high doses of medication the patients had been taking. Doctors don't quite understand this phenomenon, but they see it happen in other instances too; it is as if the patient, deadened, is again made sensate. Deanna broke out in hives and felt nauseated; her hands shook. These symptoms eased when she (as several of the patients have done) reduced her meds — slowly, so as not to introduce new variables. She now takes standard doses of Effexor, an antidepressant, and Seroquel, an anti-psychotic drug.”
The doctor said, “We're just fixing the circuit. The patient's life still needs work. It's like fixing a knee. They need that high-quality physical and supportive therapy afterward if they're really going to move around again.” ... The transition is not back to a former self and family but to a new one.
Apparently Deanna's improvement has persisted since 2004, though.
Much talk of “paradigm shift” and “the beginning of a new way of understanding” and a common denominator of depression, which we've heard before. The article notes “Other treatments have started this well and fizzled.”
poster:pseudoname
thread:627817
URL: http://www.dr-bob.org/babble/20060329/msgs/627817.html