Helen Mayberg, “Rethinking Depression and its Treatment: Insights from Studies of Deep Brain Stimulation”

I really enjoyed Dr. Mayberg's talk about depression and her work on DBS (deep brain stimulation) as a potential treatment for the future. Something she really emphasized was how we think about/how we define depression. Some key phrases that she quoted were:

• "storm of murk"
• "trance of supreme discomfort"
• "positive and active anguish"

This made it differentiated depression as, not an off state, but an on state. Unfortunately for this disease that causes state of despair is lacking a consistent, effective treatment. More than 40% of treated patients go into remission, and approximately 10% of treated patients become resistant to treatment over time. Some of the limitations of depression treatment that cause this is that there is no real pathology model, and there are no clear biomarkers of depression  Furthermore  it's hard to study the underlying basis or test the treatments due to no definitive animal models - animals have no trackable psychic pain.

Dr. Mayberg's work has been on a potential alternative to the classic depression treatment options (ECT, VNS, TMS, etc.): neuromodulation via deep brain stimulation targeting the brain region: subcollosal cingulate 25 (we talked about this region today when we discussed the reward system), whose overactivity is implicated in depression. DBS implants an electrode that then blocks aberrant cingulate 25 activity. It first only target cingulate 25, and that had pretty good success, but many times the effect wore off after some time. Then, they employed tractography to figure out the network affected, and target this circuitry - this had even better results. Patients were quoted to say that DBS "doesn't make it easy, but it makes it doable." DBS doesn't necessarily promote positivity, but just turns off negativity (negative bias).

One thing that I found kind of surprising about her methods, is that they're able to do shams, deplete the batteries, etc. I would think that this kind of research with real human patients would not allow something like controls that deprive certain patients of the treatment. Is that ethically sound?

One last thought: Dr. Mayberg emphasized at the end that recovery from depression takes more than just DBS/ECT/TMS... Depression is a feeling of helplessness, and without a complete overhaul of life with depression, life after treatment is still difficult due to depression-inducing habits. Therefore, treatment needs to encompass lifestyle changes and new motivations!