
Treating depression with deep brain stimulation - evo_9
http://www.extremetech.com/extreme/137787-curing-depression-and-super-charging-cranial-capacity-with-deep-brain-stimulation
======
gregorymichael
I am a developer, and I have Type II Bi-Polar Disorder.

For years I was crippled by intermittent depression. I failed out of school,
lost jobs and, in general, failed at life even though I was blessed with an
above average intelligence. Four years ago I started meds, and have been
remarkably stable and productive since.

If you are here because you are an entrepreneur or developer struggling with
depression, and you would like to talk about it, please feel free to contact
me.

~~~
iamleppert
curious to what medications you're taking?

~~~
gregorymichael
Lamictal (Lamotrigine).

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lutusp
The linked article's title: "Curing depression and super-charging cranial
capacity with deep brain stimulation"

This ranks as possibly the most irresponsible article title in recent memory,
and there's no shortage of candidates. To "cure" depression, we would first
need to locate and treat a causative agent. The article describes ways to
alleviate _symptoms_ of depression, but it neither discovers nor treats what
causes it.

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caycep
I work with DBS.

It's primarily used for motor disorders like Parkinson's disease and dystonia.
It works fantastically well. Patients move better and take less meds.

It's not some fancy brain programming - you can modify the signal somewhat,
but the current tech is essentially a hot-rigged Medtronic heart pacemaker
that is wired to the brain instead. You set it at around 0.5 - 3.5 V (I think
depression they often crank it up to 5-6 V, for no better reason than just
because...), around 60-120 microsecond pulse duration, and between 60-180 Hz.
So no, not in-depth brain programming yet.

For depression- it's much harder to know because the scales are much more
subjective. For PD, dystonia - easy - measure if they are moving or not. For
depression, you need a complex scale that tries to quantify "how do you feel"?
Plus, it's open label and non blinded, so yes, they are going to say, "I feel
better" after they've underwent surgery like that.

For those of you who are interested in DBS for depression, pubmed the papers
by Helen Mayberg of Emory and Andres Lozano of the University of Toronto. It's
promising, but still far from ready for prime time - studies are open label
and too preliminary.

Ironic that the major quotes are from the division head of Medtronic, who,
although he's a really smart and a really nice guy, is an executive of the
company that stand to receive financial gain. Not that they shouldn't quote
him, but they should have contacted the researchers who did the studies first.

Other issues: I think transcranial magnetic stimulation or TMS/rTMS is much
more widely used that tDCS, on the account of tDCS limits how much energy you
can zap without causing pain. There is one device that is approved for TMS in
depression- the problem is that the effects don't last too much longer after
you shut the machine off. (DBS stays on 24/7). What's scandalous about that
device is, there's some sort of disposable widget that costs >$100 a pop and
is one use only. Nice cash flow for the devive manufacturer built into the
design...

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moistgorilla
Really cool, I wonder why I hadn't heard of tDCS before this article,
especially since it doesn't seem dangerous at all.

DBS on the other hand is a little more scary because of that fact that it
requires an invasive procedure. If you can control depression couldn't you
control other emotions as well? Maybe we will get something like from "Do
Androids Dream of Electric Sheep?" where we can set our state of mind to
"professional" or "morose".

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simcop2387
I love the thought of using more targeted ECT [1] to do this. It makes me
wonder if something similar could replace almost all of the other uses for ECT
while removing a decent amount of the side-effects given the focused nature of
this. One of the biggest of which that I'm aware of is that it can cause
severe memory loss, whether it deals with the underlying problem or not.

[1] <http://en.wikipedia.org/wiki/Electroconvulsive_therapy>

~~~
phren0logy
You should also check out Magnetic Seizure Therapy, which has many
similarities to ECT but may also have fewer problems with concentration and
memory.

<http://en.wikipedia.org/wiki/Magnetic_seizure_therapy>

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tokenadult
Whew! Many, many submissions to HN are based at bottom on press releases, and
press releases are well known for spinning preliminary research findings
beyond all recognition. This has been commented on in the PhD comic "The
Science News Cycle,"

<http://www.phdcomics.com/comics.php?f=1174>

which only exaggerates the process a very little. More serious commentary in
the edited group blog post "Related by coincidence only? University and
medical journal press releases versus journal articles"

[http://www.sciencebasedmedicine.org/index.php/related-by-
coi...](http://www.sciencebasedmedicine.org/index.php/related-by-coincidence-
only-journal-press-releases-versus-journal-articles/)

points to the same danger of taking press releases (and news aggregator
website articles based solely on press releases) too seriously. Press releases
are usually misleading.

The most sure and certain finding of any preliminary study will be that more
research is needed. All too often, preliminary findings don't lead to further
useful discoveries in science, because the preliminary findings are flawed.
The obligatory link for any discussion of a report on a research result like
the one kindly submitted here is the article "Warning Signs in Experimental
Design and Interpretation" by Peter Norvig, director of research at Google, on
how to interpret scientific research.

<http://norvig.com/experiment-design.html>

Check each news story you read for how many of the important issues in
interpreting research are NOT discussed in the story.

Here, a big problem with the press-release-based submission is that depression
is a disease that goes into spontaneous remission, on different schedules for
different patients, so to say "Patient was given a treatment, and the patient
started feeling better" proves nothing when n = 1, and doesn't prove much even
with much larger sample sizes until careful statistical analysis of the
patient sample is done as part of a thoughtful comparison with a control
group. Some depression patients get better regardless of the treatment, and
some unfortunate patients stay depressed even when given treatments that are
known to be reasonably effective in the general population. Depression is a
polygenic, multifactorial disease, a disruption of the complicated mood
regulatory system in the human brain, with its several interacting feedback
loops, so no two depression patients are seeking care with exactly the same
underlying disease state.

It was interesting, by the way, to see the mention of research at Medtronic in
the submission here, as that is a LARGE local company in which many of my
friends work, and at which one of my immediate relatives worked not long ago
(although he worked on a different kind of medical device, not on a brain
device). As heart disease rates continue to decline worldwide,

[http://www.scientificamerican.com/article.cfm?id=longevity-w...](http://www.scientificamerican.com/article.cfm?id=longevity-
why-we-die-global-life-expectancy)

the former bread-and-butter of medical device companies (heart pacemakers and
other heart devices) are a shrinking part of the market, long-term, so the
medical device makers are doing research to see if other human diseases can be
treated with electrical medical devices. I think the people who conduct
research at medical device companies are persons of integrity who desire to
help sick people, but it is MUCH too early to predict that a medical device
will ever be a first-line treatment for human mood disorders. Much more
research on safety and effectiveness still needs to be done before that
happens.

P.S. There was quite a good recent thread here on HN

<http://news.ycombinator.com/item?id=4511188>

with helpful advice about what to do about depression.

~~~
seehafer
Transcranial Magnetic Stimulation (a non-invasive type of stimulation, in
contrast to DBS) is cleared as a second-line (so, after one type of meds
fails) treatment for depression.

<http://www.neuronetics.com/products-services/system/>

If we can find a way to get costs down we absolutely will make medical devices
a first-line treatment for mood disorders. There's so much more potential for
being specific and preventing the side effects associated with common SSRI
anti-depressants such as Prozac.

(I'm a neuro-focused biomedical engineer and have worked on both spinal cord
stimulation and deep brain stimulation devices)

~~~
lutusp
> ... treatment for depression.

As long as people understand that what is being treated are symptoms of
depression, not the root cause, which is unknown.

I emphasize this because, to a layman, the word "treatment" implies a method
that addresses causes, not effects. This is not the case.

If I operate on a patient and remove a tumor, I am treating cancer. If I offer
the patient a more comfortable pillow, I am not treating cancer.

The meta-issue here is the degree to which psychological conditions aren't
medical conditions (yet) -- with rare exception they don't have identified
causative agents, as a result of which treatments are symptomatic, and it's
too soon to be talking about treatments (as above) and cures (as in the linked
article's title).

Anyone who wants to claim we've either treated or cured depression need only
stop the symptomatic treatment and see what happens to the patient.

> If we can find a way to get costs down we absolutely will make medical
> devices a first-line treatment for mood disorders.

For one definition of "treatment", yes -- symptomatic relief. But not in the
general sense.

~~~
seehafer
> I emphasize this because, to a layman, the word "treatment" implies a method
> that addresses causes, not effects. This is not the case.

By this logic Tylenol is not a treatment for a headache. There are a lot of
treatments that are treating symptoms and not causes. Good doctors and nurses
will generally point this out to patients when prescribing something.

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guptaneil
I worry about how many kids will try to boost their video game performance by
trying the DIY kit at home.

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Flow
<http://www.reddit.com/r/tdcs>

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aidenn0
Mandatory link: <http://en.wikipedia.org/wiki/The_Terminal_Man>

