Sunday, June 22, 2008

Curing Depression: Deep Brain Stimulation + "Talk" Therapy

Northworthy had the pleasure of attending the Centenary lecture of the University of Toronto's Faculty of Psychiatry, Wednesday June 18, 2008. Celebrating 100 years and a large faculty, the event was well attended and the presentation by Dr. Helen Mayberg was fascinating: Deep Brain Stimulation.

Deep Brain Stimulation (DBS) was a culminating effort after a great deal of other work had been done by neuro-scientists. DBS itself is relatively trivial with a surgury to insert a 1 mm lead with a small emitter, using MRI to guide the final location of the emitter, within the brain. The lead is attached to a wire that runs over the skull down through to the shoulder where the pacemaker is placed.

The pacemaker in this case, emits a steady frequency to shut off the overactive or underactive implicated centre of a brain activity, that in the case of unresponsive depression, caused the depression to be imediately lifted.

With techniques and technology like this under pure research and development as a viable procedure, to relieve symptoms, inevitably Northworthy asked a question at the end of the presentation, discerning :

"If the causality of such a depression is an unknown, as was a given in the presentation, and the relief of symptoms the aim of such work, would the successful alleviation of the symptoms, afford the opportunity through psycho-analytic therapy or other cognitive ("talk") therapy, to discern the cause, and once identified, permanently alleviate the symptoms, and the need for the brain pacemaker?"
To this question, Dr. Mayberg, smiled and said she was not going to repeat the question but expounded on the idea for several minutes, of permanently curing the depression, to concluding that what was put forward by Northworthy was a "testable hypothesis."

Northworthy has been interested in the most difficult problems since a child, and certainly mental illness and other diseases of the mind-brain certainly rate high.

In my core thinking, since the separation of the mind and the distinctive segments of brain operation by Dr. Wilder Penfield, at McGill, the observing mind as well as the unconscious mind, detect things and reacts to events, possibly in the case of depression by blocking further painful thought and feelings (affects). In a sense Dr. Mayberg's focus on "area 25", the blockage, relieves the depression by shutting it off. The question then became obvious: with the patient's blockage alleviated, can we now explore why it was put up there in the first place?

Cases of Post Traumatic Stress Disorder where Depression presents itself to mask the causality, are not normally attactive to medical research due to funding issues from companies that hope to create a 'pill' to solve the symptoms, returning the person efficaciously to 'normal' society. In the case of Dr. Mayberg, she is affiliated with a University, and has received funding from organizations interested in pure research. Hopefully, pure research will also examine the causality of the depression, and not just the symptomolgy, even if the latter relieves the person of their depression with a potential dangerous side-effect: the ability to think of why they became depressed in the first place.

There is of course another way of thinking about this too: the depression itself was not protective but rather it just "was," a trigger of a genetic predisposition, that in earlier days would have been sufficient to cause the person to be a straggler, and a cast away. In current times, sometimes a "lepper" if institutionalized (a "mental case"), sometimes, just someone hidden in the closet, or at home.

Either way, depression is rapidly overtaking any other illness as the largest cost to Canada in the billions in lost productivity and health care costs.

The conclusion of Northworthy is that the future is indeed much brighter for the work of Dr. Mayberg, and other scientists, in cross discipline approaches, where say material science gains in nano-technology, are providing the opportunity to treat at the molecular level illnesses, fighting against the DNA - the genes - we all carry as triggers, predispositions and time-bombs to diseases and to what may be premature death.

In the biggest picture, "cancer" as we knew it, will within the next 10 years be something we all can know about, and by choices, deal with in advance.

The horrible news however is that in terms of genetic counselling, we as a society are more concerned with cosmetic procedures, luring the medical graduates away from what we will need more of as difficult questions of ethics, cost, continued living, arises with future genetic testing, where we are sorely lacking the professional expertise to deal with conclusive test results.

For more reading on this breakthrough, "A Depression Switch? New York Times Magazine" and an interview with Dr. Helen Mayberg, "Deep Brain Stimulation for Treatment-Resistant Depression: An Expert Interview With Helen S. Mayberg, MD."

Here is also a Charlie Rose show where Dr. Mayberg is a guest. It is discusses the state of the art in the sciences (I watched this live).

Another link of interest might be

1 comment:

Anonymous said...

One person suffering from depression might have trouble sleeping while another has trouble doing anything but sleeping. Appetite can also be affected by depression. Some people eat more to fill up the hole they feel inside themselves. Others just stop eating at all.