
Deep-Brain-Stimulation Treatment for Depression Fails Another Trial - cpncrunch
http://blogs.scientificamerican.com/cross-check/much-touted-deep-brain-stimulation-treatment-for-depression-fails-another-trial/
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jacquesm
Good. The more of this junk science gets shot down the better. Let's see more
of these articles rather than the ones about miraculous new inventions to cure
cancer/Alzheimers/diabetes/insert your favorite disease. The carelessness with
which these findings are shot into the world and the amount of press they get
before there is even a proper chance to evaluate the findings, to review the
experimental setup and possible biases and to replicate the results is very
annoying. Not a day goes by without an announcement of that kind, the number
of times I've seen 'cure for X' in the headline of some article that then
later gets retracted (usually very quietly) is depressing. Maybe I should get
some deep-brain-stimulation to counteract that effect.

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caycep
It's science(and I can say this knowing the researchers). The trials were done
rigorously and according to regulatory requirements. The results may be
negative, but they are valid results.

What it means for depression and DBS down the line remains to be seen. I agree
w/ the poster below that a lot may depend on how you define depression; one
critique may be that surgical candidates were not all suffering from the type
of depression affecting the subcallosal cingulate area.

Of course the rationale for actually implanting the devices in the subcallosal
cingulate were based on PET and fMRI results; and many in the imaging field
regard those techniques as "junk science" but that is an argument with many
barbs and perhaps better saved for another day...

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cpncrunch
>The results may be negative, but they are valid results.

Except they were mostly (if not all) uncontrolled. Uncontrolled trials for
depression are bad science, because the placebo effect has such a large
effect. Even if an open-label trial for depression is successful, it tells you
absolutely nothing.

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caycep
The one cited in the link was controlled and blinded using sham stimulation in
the group. The problem isn't that it wasn't controlled, it may not have been
powered (n=30ish?) enough to reliably detect a difference...which is the main
bugaboo in clinical science. Recruiting enough people into the study to make
it meaningful is the hard and expensive part.

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crimsonalucard
The brain is a black box of complexity. Until we completely understand what's
going on we don't even know if we're treating something that is even fixable.
It's like adding random voltages to pins on a motherboard to try to fix a
software bug.

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hmahncke
Deep brain stimulation for Parkinson's is pretty incredible [1] and
transcranial magnetic stimulation for depression is effective [2]. The open
label studies on DBS for depression were promising, so it was perfectly
reasonably to try it out in a randomized controlled trial.

[1]
[http://www.ninds.nih.gov/disorders/deep_brain_stimulation/de...](http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm)
[2]
[http://www.medscape.com/viewarticle/804736](http://www.medscape.com/viewarticle/804736)

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caycep
DBS for Parkinson's (and dystonia and essential tremor) work reliably well,
and the complication rates are considered acceptable. However, in terms of
understanding the mechanisms of how they work on the brain, I would very much
characterize it as a black box. So much so that if you look at the different
ways different medical centers and practitioners program the devices, it's
clear we don't know how it works; just that it does (and extremely
effectively) once you fiddle around with the settings long enough.

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kmfrk
Is this referring to Vagus Nerve stimulation or something different?

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cpncrunch
It's different:

[https://en.wikipedia.org/wiki/Deep_brain_stimulation](https://en.wikipedia.org/wiki/Deep_brain_stimulation)
[https://en.wikipedia.org/wiki/Vagus_nerve_stimulation](https://en.wikipedia.org/wiki/Vagus_nerve_stimulation)

Vagus nerve stimulation doesn't seem to be any better:

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990624/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990624/)

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dschiptsov
Perhaps, because Depression is nothing but a set of acquired habits (self-
conditioning) which could be un-learned/altered (through applying a CBT -
systematic behavior change) by acquiring a different set of new habits.

