Treating depression with deep brain stimulation
extremetech.com
extremetech.com
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.
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.
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...
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".
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...
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...
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.
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)
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.
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.