As I've hoped and hypothesized, Dr. Mayberg, who is one of the founders of using DBS for depression, has released research under a NIH grant relating to being able to diagnose what treatment method will work best for each individual with depression. i.e. Run the test and it will show whether an SSRI, SSNI, Cognitive Behavior Therapy (CBT) or something more radical like DBS stands the best chance of working. (They haven't refined it that far but the initial research is fantastic).
In the linked article, they correlated activity in the brain called the "anterior insula" with CBT and a SSRI. Based on either low or high activity in the insula, the type of treatment that worked best for the patient has a high correlation. Another article (http://www.medscape.com/viewarticle/806426) gets a little more technical and the actual JAMA article is at http://archpsyc.jamanetwork.com/article.aspx?articleid=1696349.
Pretty cool stuff, if you ask me. Of course this is all very preliminary work but it's a giant step forward.
For those interested in DBS, there are a number of research studies using different locations in the brain. There are links to the side and in the blogs that refer to the actual locations and that the current theories hold that, like many things in the brain, depression is a circuit of sorts. That circuit runs through a number of areas and the current research is showing that there are a number of places that DBS works. Finding the place that works the best or to extend this latest research, using some type of imaging may lead to prescribing a certain anti-depressant, seeing a therapist, or in severe cases, which place in the brain to insert some electricity.Woo hoo.
Showing posts with label Broaden DBS. Show all posts
Showing posts with label Broaden DBS. Show all posts
Saturday, June 29, 2013
Sunday, April 14, 2013
Hope
Hope is one of the hardest things to muster when suffering deep depression. Unfortunately, too many lose that last ember of hope. I'm publishing a couple of really exciting links. I've mentioned before that there are numerous DBS studies around. I usually only hear from those in the US in the St. Jude study.
The first is great news - if the USA can find the money. It confirms what I predicted many blogs back - that the amount of research and technology advancements that we've seen in the last 30 years regarding the heart, will be replaced by research of the brain. (throw in the human genome project as another great step forward). Here is the NY Times link, but HOPEfully everyone suffering from depression understands the potential of 10 years of concentrated study of the brain:
http://www.nytimes.com/2013/02/18/science/project-seeks-to-build-map-of-human-brain.html?pagewanted=all&_r=0
Next up, and the impetus for me to write about it is the research in Germany where they are implanting it yet another area. I won't attempt to explain the different areas being explored but they all seem to be interconnected in a circuit, that when disrupted, provides relief from this Hell called Major Depressive Disorder.
http://neurosciencenews.com/deep-brain-stimulation-medial-forebrain-bundle-success-major-depression-patients/
Another link about the same study: http://www.business-standard.com/article/pti-stories/brain-pacemaker-to-treat-acute-depression-113041000157_1.html
And here is the HOPE... for anyone wishing they could get in a study or find ANY way to rid themselves of this disease, hang on. This is the third "successful" area of the brain that I am aware of to be probed. I personally believe we will discover there are multiple 'depressions' and different treatments will be developed for each. I've seen the inside research on some new TMS that is outstanding (but not yet available at your pharmacy).
Not being a brain surgeon, I'm not sure if this is the same area Bonn was playing with before or not. It sounds like a new area - so there may be 4 areas being studied, plus things like VNS and TMS.
But this is exciting news.
There is good reason to have HOPE.
The first is great news - if the USA can find the money. It confirms what I predicted many blogs back - that the amount of research and technology advancements that we've seen in the last 30 years regarding the heart, will be replaced by research of the brain. (throw in the human genome project as another great step forward). Here is the NY Times link, but HOPEfully everyone suffering from depression understands the potential of 10 years of concentrated study of the brain:
http://www.nytimes.com/2013/02/18/science/project-seeks-to-build-map-of-human-brain.html?pagewanted=all&_r=0
Next up, and the impetus for me to write about it is the research in Germany where they are implanting it yet another area. I won't attempt to explain the different areas being explored but they all seem to be interconnected in a circuit, that when disrupted, provides relief from this Hell called Major Depressive Disorder.
http://neurosciencenews.com/deep-brain-stimulation-medial-forebrain-bundle-success-major-depression-patients/
Another link about the same study: http://www.business-standard.com/article/pti-stories/brain-pacemaker-to-treat-acute-depression-113041000157_1.html
And here is the HOPE... for anyone wishing they could get in a study or find ANY way to rid themselves of this disease, hang on. This is the third "successful" area of the brain that I am aware of to be probed. I personally believe we will discover there are multiple 'depressions' and different treatments will be developed for each. I've seen the inside research on some new TMS that is outstanding (but not yet available at your pharmacy).
Not being a brain surgeon, I'm not sure if this is the same area Bonn was playing with before or not. It sounds like a new area - so there may be 4 areas being studied, plus things like VNS and TMS.
But this is exciting news.
There is good reason to have HOPE.
Saturday, February 9, 2013
Interesting Ethics
A person who contacted me has this link posted on their facebook. Absolutely interesting article. (It is a pay per view research paper but the first 2 pages are worthwhile). This isn't to try and scare anyone away from the procedure but to highlight the fact that the research going on is dealing with some of the worst depression imaginable and there are risks.
As a long time advocate of the research protocol mandating that a person be assigned to a counselor or therapist, I believe Dr. Gilbert has made the point. My opinion, for what it is worth, is that a therapist (who may be blind to whether the person is turned on or not) should check in with patients for the first few weeks after every visit for a "tune-up". And of course, be available whenever the person needs someone to talk with.
As a general statement, we don't like socializing much and definitely don't like talking about how we feel if the gizmo doesn't seem to be working. But ethically, I would think the IRBs should require it. (And not just for us depressed, but probably for all experimental DBS).
As for me..... nothing really new to report. What I've discovered in myself though is much less interest in following the subject. It's almost like a denial reflex that I should stay abreast of all the research on DBS. Not reading about it makes it not real for me, so to speak. I'm overall pleased with the continuing research into TRD and depression in general. Some of the outcomes of the latest TMS are FASCINATING to say the least, but I find myself less "glued" to the Internet over depression. Denial is a wonderful thing.
Best to all. Wish NM would contact me.
As a long time advocate of the research protocol mandating that a person be assigned to a counselor or therapist, I believe Dr. Gilbert has made the point. My opinion, for what it is worth, is that a therapist (who may be blind to whether the person is turned on or not) should check in with patients for the first few weeks after every visit for a "tune-up". And of course, be available whenever the person needs someone to talk with.
As a general statement, we don't like socializing much and definitely don't like talking about how we feel if the gizmo doesn't seem to be working. But ethically, I would think the IRBs should require it. (And not just for us depressed, but probably for all experimental DBS).
As for me..... nothing really new to report. What I've discovered in myself though is much less interest in following the subject. It's almost like a denial reflex that I should stay abreast of all the research on DBS. Not reading about it makes it not real for me, so to speak. I'm overall pleased with the continuing research into TRD and depression in general. Some of the outcomes of the latest TMS are FASCINATING to say the least, but I find myself less "glued" to the Internet over depression. Denial is a wonderful thing.
Best to all. Wish NM would contact me.
Saturday, June 9, 2012
I Miss Me
Over the Memorial Day weekend I drove by the housing addition where Depression first showed itself. It was house #2. Ironically in my little berg of a town, at one time you could see house #1 from the yard of house #2 (before more construction). House #1 memories are full of laughter and fun. House #2 memories have many of those but in looking back - now I see some of the slippage. How horrifying to look back in this manner.
House #3 was a short stay and was the same as House #2. House #4 is where Depression was diagnosed. But back to house #2. Looking back over 16 years finds a family flourishing when we moved in. When we moved out, there was pain for me personally, pain at work and pain in the marriage. (In psycho-babble (PB), three domains were becoming dysfunctional). But it is the beginning of house #2 that I compare to the worst (both house #4 & #5). Who was I back then?
Besides the obvious lack of the symptoms that plague every depression patient, it hit me that my impulsivity was overwhelmingly different. No second thoughts to doing things spur of the moment nor even volunteering for new projects. Some of my impulsivity was acted out immaturely as well (but I'll skip the embarrassing mistakes). Along with the impulsivity came the ability to talk in front of crowds with no anxiety; the ability to 'want' to meet new people; the ability to take on new situations.
From studying motivation theory, I know that our brains are wired for the new and novel. Some brains are wired more heavily than others and there is also wiring related to risk taking or danger. People wired heavily for seeking out the new and novel combined with high risk taking are called adrenaline junkies. In my teen years, riding motorcycles and driving cars at stupid speeds was normal. My executive functioning was low. (PB for immature frontal lobe development). But that immaturity continued well into late twenties, although tempered by 'responsibilities', so potentially lethal impulses were kept at bay. But at house #2, the decline of the impulsivity (which should have equated to becoming more mature) continued past a certain threshold of 'normalcy' to the point that by house #4 I would find myself crying in the shower not wanting to start my normal day. New and novel was triggering the danger circuits. Which then begs the question, was it the New & Novel decline or was it the Danger circuit being over zealous? (This thought just came to me while writing this - no wonder therapists prescribe journaling for insight).
If I look at financial risk - danger - I was just as risk adverse while playing the stock market at house #4 as house #2. Flirting while being married didn't decrease either - although that would be an argument for my New and Novel not really declining as much as I think. And at house #4 I bought a 400 horsepower car - definitely a sign that my Danger circuit wasn't overtaking my reasoning. So I'm back to the New & Novel decrementing being the cause of my dysfunction. The depression's ability to cause a low mood was tempered with psychopharmacology (antidepressants) and I believe (heavily believe) that memory is very closely tied to emotional states. (Remember when you got gifts? But not the day before?) And my antidepressants suppressed the emotional state in both directions. Often referred to as raising the floor but also lowering the ceiling in mood categorizations.
So the lack of emotion led to fewer memories overall. The good times and bad were hampered at the time and the memory circuits weren't locked in as deeply. I can recall house #2 memories more easily than towards the end at house #4. Was that Depression or the side effects? I'll have to go with Depression, because during that period of time I was on SSRIs, SNRIs, and tricyclene medications (not all at once - but my gp would switch when we realized the medication I was on was no longer working). So as the Depression became worse, regardless of the medication, the memories were etched less and less on my brain. And God I regret that. When my children bring up memories that should be easily accessed, I struggle. A few hours later, I can remember more of the moments they were talking about. (I know - some of this is simply age - but when discussing it with chronological peers, their lack of important memories isn't nearly as severe as mine).
Back to missing ME. I think in a previous blog, I referred to confidence as being the culprit. (I'll have to go read my own blog because I don't completely remember!). But behind the confidence, I now believe impulsivity played a part. I'm now curious if the Depression circuit, which gizmo is interrupting, is anywhere close to the New & Novel circuitry. I know gizmo is wired really really close to the Danger circuitry - at least the anxiety response portion of that.
No fear of being goofy. That's another trait I was thinking about when I drove by house #2. That is impulsivity but is also part of the Danger (fear response) circuit. Interesting. The second most salient trait I was thinking about 2 weeks ago has both components - almost equally. "fear of" = fight or flight and "being goofy" = impulsive comedic behavior. Ok, I'm back to the drawing board as to which is affected more by Depression. (this stream of conscience writing stuff makes me sound wishy-washy and its possible this blog post will make me look goofy - although it's been 2 weeks since I had the impulse to write this down, and haven't acted on it until now - yet I will push save).
Most of my posts have links to some good reading. I have been reading some interesting articles, but don't really want to take the time to go back and find the links again. In summary, there is a flurry of activity surrounding DBS for depression and the numbers are increasing. As mentioned before, the Europeans have a study group with 4 leads. Some of their research is starting to surface. From my layman's understanding, they've plugged into the same place as both St. Jude's project as well as Medtronics area. With the working theory that the circuit passes through a number of physical locations in the brain and can be interrupted at various places along the way.
There is also a lot more being published about transcranial magnetic stimulation (TMS). And the general public is becoming more aware of the use of electrical (and magnetic) stimulation of all of us guinea pigs, with an amazing (to me) outcry of negativity. Summarizing a couple of people's points in an article that likened my gizmo as a pacemaker for the brain, heart pacemakers work on a muscle and DBS works on a part of the body that we know very little about, in fact we know more about the moon than we do the human brain.
Well, to that I would like to remind people that we put quite a few lives at risk in moon research. (Some of it could have been done without humans - I get that). As we map out these circuits, I believe it won't be very long before we can put a person in an fMRI and decide whether to put them on zoloft; attach some low voltage electrodes to their skull; send them to talk therapy; put a magnetic skull cap on 3 times a week; or drill a couple of holes in their heads. Just like we know now whether to make a person reduce their salt & exercise more; or put them on cholesterol, blood thinners or beta blocker medicine; or have to do open heart surgery followed by a pacemaker. (I understand the heart is a muscle and the brain is different - so what? Research may take longer and ethics/research boards may be more cautious, but bottom-line folks, the research has to be done.
Hmmm, after I proof read this and post, I may fire up the 400 horse beast and see what 100 mph feels like again. JUST KIDDING - the last time I broke 90 mph cost me over $400. But I am going to be more aware of when I could be more impulsive and actually try to be goofy (in small amounts). (Physician heal thyself?)
House #3 was a short stay and was the same as House #2. House #4 is where Depression was diagnosed. But back to house #2. Looking back over 16 years finds a family flourishing when we moved in. When we moved out, there was pain for me personally, pain at work and pain in the marriage. (In psycho-babble (PB), three domains were becoming dysfunctional). But it is the beginning of house #2 that I compare to the worst (both house #4 & #5). Who was I back then?
Besides the obvious lack of the symptoms that plague every depression patient, it hit me that my impulsivity was overwhelmingly different. No second thoughts to doing things spur of the moment nor even volunteering for new projects. Some of my impulsivity was acted out immaturely as well (but I'll skip the embarrassing mistakes). Along with the impulsivity came the ability to talk in front of crowds with no anxiety; the ability to 'want' to meet new people; the ability to take on new situations.
From studying motivation theory, I know that our brains are wired for the new and novel. Some brains are wired more heavily than others and there is also wiring related to risk taking or danger. People wired heavily for seeking out the new and novel combined with high risk taking are called adrenaline junkies. In my teen years, riding motorcycles and driving cars at stupid speeds was normal. My executive functioning was low. (PB for immature frontal lobe development). But that immaturity continued well into late twenties, although tempered by 'responsibilities', so potentially lethal impulses were kept at bay. But at house #2, the decline of the impulsivity (which should have equated to becoming more mature) continued past a certain threshold of 'normalcy' to the point that by house #4 I would find myself crying in the shower not wanting to start my normal day. New and novel was triggering the danger circuits. Which then begs the question, was it the New & Novel decline or was it the Danger circuit being over zealous? (This thought just came to me while writing this - no wonder therapists prescribe journaling for insight).
If I look at financial risk - danger - I was just as risk adverse while playing the stock market at house #4 as house #2. Flirting while being married didn't decrease either - although that would be an argument for my New and Novel not really declining as much as I think. And at house #4 I bought a 400 horsepower car - definitely a sign that my Danger circuit wasn't overtaking my reasoning. So I'm back to the New & Novel decrementing being the cause of my dysfunction. The depression's ability to cause a low mood was tempered with psychopharmacology (antidepressants) and I believe (heavily believe) that memory is very closely tied to emotional states. (Remember when you got gifts? But not the day before?) And my antidepressants suppressed the emotional state in both directions. Often referred to as raising the floor but also lowering the ceiling in mood categorizations.
So the lack of emotion led to fewer memories overall. The good times and bad were hampered at the time and the memory circuits weren't locked in as deeply. I can recall house #2 memories more easily than towards the end at house #4. Was that Depression or the side effects? I'll have to go with Depression, because during that period of time I was on SSRIs, SNRIs, and tricyclene medications (not all at once - but my gp would switch when we realized the medication I was on was no longer working). So as the Depression became worse, regardless of the medication, the memories were etched less and less on my brain. And God I regret that. When my children bring up memories that should be easily accessed, I struggle. A few hours later, I can remember more of the moments they were talking about. (I know - some of this is simply age - but when discussing it with chronological peers, their lack of important memories isn't nearly as severe as mine).
Back to missing ME. I think in a previous blog, I referred to confidence as being the culprit. (I'll have to go read my own blog because I don't completely remember!). But behind the confidence, I now believe impulsivity played a part. I'm now curious if the Depression circuit, which gizmo is interrupting, is anywhere close to the New & Novel circuitry. I know gizmo is wired really really close to the Danger circuitry - at least the anxiety response portion of that.
No fear of being goofy. That's another trait I was thinking about when I drove by house #2. That is impulsivity but is also part of the Danger (fear response) circuit. Interesting. The second most salient trait I was thinking about 2 weeks ago has both components - almost equally. "fear of" = fight or flight and "being goofy" = impulsive comedic behavior. Ok, I'm back to the drawing board as to which is affected more by Depression. (this stream of conscience writing stuff makes me sound wishy-washy and its possible this blog post will make me look goofy - although it's been 2 weeks since I had the impulse to write this down, and haven't acted on it until now - yet I will push save).
Most of my posts have links to some good reading. I have been reading some interesting articles, but don't really want to take the time to go back and find the links again. In summary, there is a flurry of activity surrounding DBS for depression and the numbers are increasing. As mentioned before, the Europeans have a study group with 4 leads. Some of their research is starting to surface. From my layman's understanding, they've plugged into the same place as both St. Jude's project as well as Medtronics area. With the working theory that the circuit passes through a number of physical locations in the brain and can be interrupted at various places along the way.
There is also a lot more being published about transcranial magnetic stimulation (TMS). And the general public is becoming more aware of the use of electrical (and magnetic) stimulation of all of us guinea pigs, with an amazing (to me) outcry of negativity. Summarizing a couple of people's points in an article that likened my gizmo as a pacemaker for the brain, heart pacemakers work on a muscle and DBS works on a part of the body that we know very little about, in fact we know more about the moon than we do the human brain.
Well, to that I would like to remind people that we put quite a few lives at risk in moon research. (Some of it could have been done without humans - I get that). As we map out these circuits, I believe it won't be very long before we can put a person in an fMRI and decide whether to put them on zoloft; attach some low voltage electrodes to their skull; send them to talk therapy; put a magnetic skull cap on 3 times a week; or drill a couple of holes in their heads. Just like we know now whether to make a person reduce their salt & exercise more; or put them on cholesterol, blood thinners or beta blocker medicine; or have to do open heart surgery followed by a pacemaker. (I understand the heart is a muscle and the brain is different - so what? Research may take longer and ethics/research boards may be more cautious, but bottom-line folks, the research has to be done.
Hmmm, after I proof read this and post, I may fire up the 400 horse beast and see what 100 mph feels like again. JUST KIDDING - the last time I broke 90 mph cost me over $400. But I am going to be more aware of when I could be more impulsive and actually try to be goofy (in small amounts). (Physician heal thyself?)