A Depression Switch?
By Robbye Plummer
I recently read an article, written by David Dobbs for the New York Times Magazine, which presents a new method for treating profound clinical depression. There is not enough space to print in its entirety, so I have significantly condensed the article. If you are interested in reading the entire article, please contact me at 690-5105, and I will copy it for you.
Deanna Cole-Benjamin never figured to be a test case for a radical new brain surgery for depression. Her youth contained no problems; her adult life was blessed. She married at age 22, had three children during the 1990’s, and lived in a comfortable home. She was a public health nurse and loved her work. But in the last months of 2000, apropos of nothing – no life changes, no losses – she slid into depression of extraordinary depth and duration.
Her doctor prescribed progressively stronger antidepressants, but they scarcely touched her. A couple of weeks before Christmas, she stopped going to work. The simplest acts – deciding what to wear, making breakfast – required immense will. Desperate to escape her pain, she went to see her doctor. She was hospitalized, and there in that locked ward, she would spend the next 10 months. In fact, she spent 85% of her time in the hospital for the next three years.
In the spring of 2004, Deanna’s psychiatrist at the hospital received a fax from a University of Toronto research team asking if he had an appropriate candidate for a clinical trial of a new, experimental surgery for treatment-resistant depression. The operation borrowed a procedure called deep brain stimulation (D.B.S.), which is used to treat Parkinson’s. It involves implanting electrodes in a region near the center of the brain called Area 25 and sending in a steady stream of low voltage from a pacemaker implanted in the chest. One of the study’s leaders, neurologist Dr. Helen Mayberg, had detected in depressed patients what she suspected was a crucial dysfunction in Area 25’s activity and hypothesized that the electrodes might modulate the area and ease the depression.
At age 41, Deanna and her husband felt they had tried everything and had nothing to lose….except hopefully, her depression, so she had the surgery. Eight of the 12 patients the doctor operated on, including Deanna, felt their depressions lift while suffering minimal side effects – an incredible rate of effectiveness in patients so immovably depressed. Nor did they just vaguely recover. Their scores on the Hamilton depression scale, a standard used to measure the severity of depression, fell from the soul-deadening high 20’s to the single digits – essentially normal. They re-engaged their families, resumed their jobs and friendships, started businesses, took up hobbies old and new, and replanted dying gardens. They regained the resilience that distinguishes the healthy from the depressed.
Many scientists following the trial say they believe it will change how psychiatrists define and treat mood disorders. Focus on Area 25 tests the emerging “network” model of mood disorders, a new way of looking at psychiatric conditions that isn’t restricted by the neurochemical model of mood that has dominated over the past quarter century or so. Rather, it incorporates neurochemistry into the concept of the brain as a circuit board or wiring diagram. The network model carries profound implications for research and, ultimately, treatment. The Prozac revolution showed everyone that tweaking neurochemistry can dampen and sometimes extinguish depression – but only through a generalized approach, hitting the entire brain; and the 50% success rate of antidepressant drugs suggests that they aren’t hitting depression’s central mechanism. The network approach focuses on specific nodes, pathways and gateways that might be approached with various treatments – electrical, surgical or pharmacological. This small trial appears to confirm this model so emphatically that it’s already changing the neuropsychiatric view of the brain and the direction of research.
In the end, the procedure’s greatest value may lie in inspiring less intrusive ways of tweaking key nodes – localized delivery of drug or gene therapies, or other means still to come. However, such possibilities probably lie at least a decade away.
Robbye Plummer is Director of Planning & Public Relations at the Betty Hardwick Center. Mental Health Matters is sponsored by the Mental Health Association, phone (325) 673-2300, e-mail mhaa@bitstreet.com. Need help? Call the Hope Line (325) 677-7773.
Robbye Plummer is director of planning & public relations at the Betty Hardwick Center