Deep Brain Stimulation: a cyberpunk cure for depression?

ben ward
Ben Ward had lived with treatment resistant depression for over five years. This wasn’t just the regular ebb and flow of human emotion, or a sadness with a logical cause: overnight, Ben had changed from a lively, outgoing guy with a career to a virtual recluse. Things that had once brought Ben joy now offered nothing but the feeling of loss. Mixing with people, even longtime friends, was very difficult. The negative impacts of his mental health issue were evident, as Ben stopped enjoying outdoor sports such as surfing, cricket and riding motorbikes, had difficulty sleeping, and often returned home from work in a terrible state. After three years of this roller-coaster Ben finally had to put his career aside because he just couldn’t deal with the pressure anymore. The drive to die by suicide became a near-constant urge in the back of his mind, which understandably terrified Ben’s devoted parents.

Onset

Ben was volunteering for a Christian charity organisation in China at the initial onset of his depression. He soon returned to Australia to seek medical help with a psychiatrist and, as you’d expect, Ben’s doctor gave him drugs, including assorted types of antidepressants, but none of them seemed to make any difference. Eventually, Ben had tried fifteen kinds of pills with no relief, learned cognitive behavioural therapy (CBT) with his psychiatrist and even made the decision to undergo four courses of ECT (electroconvulsive therapy). The shock therapy allowed Ben to feel better for a couple of weeks, but he’d quickly degrade back to misery. Despite the temporary nature of its beneficial effects, ECT allowed Ben to survive for those five years, and he believes it would have been a lot harder without it. One of the main drawbacks of ECT, memory loss, was actually helpful!

It soon became apparent that this wasn’t just your basic, garden variety depression: Ben’s illness was the treatment-resistant sort, which meant it was a much, much worse type that would be unlikely to improve any time soon.

Finally, after a time of desperate prayer for relief from his depression, Ben discovered a surgical procedure called deep brain stimulation, or DBS. There are many ethical debates and controversies around using surgery to treat psychiatric disorders thanks to the barbaric history of psychosurgery, but this didn’t stop Ben’s investigations. He wanted to be cured.

Ben managed to get onto the waiting list to undergo the procedure as a part of a research project down in Melbourne. Unfortunately, the project was shelved due to a lack of funds, so Ben started to look further than his own backyard in places like Canada and the USA. After some research, Ben found a new hope waiting in India and sent an email to a guy called Doctor Paresh Doshi.

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Important note

Deep brain stimulation has no links to lobotomy or other forms of destructive psychosurgery and is NEVER done against a patient’s will. Nothing is cut out or damaged with DBS. In fact, DBS has been around for decades and can be a very effective treatment for Parkinson’s disease and Tourette’s Syndrome. Using DBS for treatment-resistant depression was banned in NSW some time ago, though a number of places overseas (such as Canada) are in the latter stages of research into this particular application.

Off to India

Before Ben came along, twenty-nine patients with treatment-resistant depression had been evaluated for DBS surgery in India, but none of them could meet all of the set criteria. To undergo DBS, patients must:

  • be below the age of 60
  • have had no response to anti-depressants from several distinct pharmacological classes, and these aforementioned drugs must have been used at the maximum possible dose for a set number of months
  • have had no long term response to cognitive behavioural therapy and ECT

After taking a good look at Ben’s file, Indian surgeon Dr Doshi – director of the neurosurgery department at Jaslok, India – had a discussion with Ben’s psychiatrist in Sydney. Dr Doshi had already performed more than two-hundred and fifty DBS procedures for people with Parkinson’s and other movement disorders, making him the most qualified guy in all of India to use DBS for such a purpose. Ben’s case was also evaluated by Dr Doshi’s team of eight doctors including neurologists, neurosurgeons and psychiatrists, and they all agreed that Ben was the ideal candidate.

Ben was soon invited over to exotic India to become the first DBS recipient for depression in the whole of India and south-east Asia. You could call Ben just as much of a pioneer as the surgeons!

Flipping the happiness switch

Ben, head shaved bald, was wheeled into the operating theatre and fixed into a rigid stereotactic frame. Since each human brain is different, these frames are designed to give the surgeon a stable reference point. CT scans and MRI images helped Dr Doshi to pinpoint his precise target. Dr Doshi drilled several small holes into Ben’s skull, inserted tiny hollow tubes through the pits, then pushed hair-like DBS electrodes into the tubes. The electrodes had to be placed into Ben’s “white matter,” which is known in neurosurgical mapping as Area 25 (a chunk called the “subgenual cingulate gyrus”, the part blamed for clinical depression by experts). Research has shown that Area 25 is usually overactive in people with treatment-resistant depression, and is best described as a sort of “gate” that allows negative feelings to flood through. Obviously the process is more complex than that, but you get the idea. Through DBS, the doctors have found a way to “close” this gate.

(A thought that occurs is: what opened the gate in the first place? -Ed)

A pacemaker was implanted into Ben’s upper chest where it would transmit a tiny current into the electrodes in his brain. The current, which is a tenth of a single percent of what you’d need to run a light bulb, constantly stimulates Area 25 for round-the-clock relief.

Ben was awake for this entire process, but local anaesthetic numbed the pain. He did experience some discomfort, as you’d expect, though it was bearable – Ben compared it to a trip to the dentist. He was far more worried about the procedure not working and having to live with treatment-resistant depression for the rest of his life.

Physically, the surgery had been a success. Time would reveal to what degree.

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Fourteen months on

Fourteen months have passed since Ben’s procedure, and Ben reports that he’s “10 out of 10.” Ben’s parents, Colin and Lyndal, say they’ve noticed a massive improvement in their son since the surgery.

“The fact that he’s talking to us again is proof enough,” Colin said.

Ben’s doctors are still cautiously optimistic.

“This is an ongoing treatment. It is not like appendectomy where you remove an organ and the patient becomes symptom-free,” Dr Doshi explained. “It’s like hypertension, or diabetes. It needs to be managed actively. It does not (just) go away.”

This whole treatment-resistant depression ordeal has understandably been a very distressing process for Ben’s parents. Ben had ceased to be the “happy child” his parents had raised and become a total stranger. To have the real Ben back was an answer to a thousand prayers after such a long time in the helpless darkness.

In more great news, not only has Ben recovered enough to engage in social events such as church and Bible study, he’s also back to working full-time. Long-discarded hobbies such as going to the beach with friends and riding bikes have regained their appeal. He’s even found love!

Ben has returned.

Controversy?

There are major differences between DBS and psychosurgical butchery such as transorbital lobotomy. For instance, DBS is never done without somebody’s informed consent, the procedure is not destructive, and is used purely as a last resort. In Ben’s case, treatment-resistant depression had crippled him so completely that he would have braved far worse in the hope of finding a cure. Ben’s spectacular recovery may give hope to to the hundreds of thousands of people out there currently suffering with the same problem, let alone the countless others in the future.

Ben says…

“This is huge! DBS works like ECT, but permanently. Research from Canada shows that NO patients have developed a resistance to the benefits of DBS, and there aren’t any long-term negative side effects, either. Australians need to know about this, as the old ways of dealing with treatment resistant depression just don’t work for thousands of people. Allowing DBS to be performed over here will definitely reduce the suicide rate, which should be more of a priority than being blinded by old fears. After all, without DBS, I may be dead by now. It changed my life, and I want it to change the lives of all those other people going through the hell I experienced.”

despair-513528_1280What is treatment-resistant depression?

“Treatment-resistant depression” is the clinical term for an episode of major, chronic depressive disorder which doesn’t respond to anti-depressants. About one person in ten with major depression will escalate to this severe variety. They will usually be prescribed drugs in combination with non-medicinal treatments like cognitive behavioural therapy, electroconvulsive therapy and transcranial magnetic stimulation, as pills alone will not be enough.

Many people think that “depression” is an emotion – like sadness – but depression is actually a disease. Depressive disorders cause a profound sense of despair and helplessness, and will often leads to sleep disorders, fatigue, loss of appetite, constipation and many other physical problems. Major depression has the potential to push a person to substance abuse and even suicide, especially without treatment, but for people with treatment-resistant depression it can be even worse.

The probability of any given person on the planet having a depressive disorder in the space of a year is about 6 to 10 percent. Depression is prevalent across all socioeconomic classes, but is more common among women than men. According to the World Health Organisation, in the next 10 years depressive disorders will be the third leading cause of disability among adults in Australia (right after heart problems and infectious diseases like AIDS).

Though drugs, psychotherapy and other alternative therapies can work in many cases of depression, about one-third of depression patients simply won’t recover. People with depression who don’t get relief from conventional treatments are said to have “treatment-resistant depression” and may be eligible for Deep Brain Stimulation (DBS) surgery in extreme cases. DBS is always a last resort, and gaining any significant improvement from DBS surgery may take months. Anti-depressants will usually have to continue to be taken even after DBS, though their dosage levels can be adjusted subsequently depending on the patient’s clinical progress.

Thanks to Swagata Yadavar, Ben and week.manoramaonline.com

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