Ramblings of an old Doc

 

Many folks have asked for “medical stuff” (enough computer viruses how about human ones?) so, this is about some gadgetry which has caused an earthquake in the treatment of depression.

Many folks have episodes of Depression through their lives, tied to events or not. In most, they resolve without the need for intervention. In many though, medications (thank G-d for them) are needed (and they work well for most, Mr. Cruise). They aren’t uniformly successful, and can cause problems (occasionally severe). They often need change, and for those in whom they failed, or caused other problems only behavioral therapy or ECT (electro-convulsive shock) remained as possibilities.

Now there’s something new: DBS (Deep Brain Stimulation). This form of therapy was initially found for movement disorders (Parkinson’s disease, and the like), and experimentally for anti-pain treatment.

In this form of treatment, electrodes are placed by a Neurosurgical team in problem areas. These devices work very similarly to heart pace makers: There’s a battery and miniprocessor (externally programmable) and electrodes (single or double) on wires placed beyond the problem area of electrical blockage. Some of these devices also function as defibrillators.

So, what does it look like?

Just like that.

Where does it go? In Brodmann Area 25 which is a sort of “conduit” of fibers going from the frontal lobe to the limbic area (regular and in 3D from the Wikipedia):

 

 

Graphically:

 

And in real life:

 

So, the patient is mildly sedated during the procedure and as electrodes are stimulated, describes his/her feelings. Various electrodes along the wire are stimulated until a helpful one is found. The generator is then programmed and placed under the skin (just like a pacemaker) and wires run under the skin to a connection point (in the xray, the four horizontal bars).

So…. As requested… some medical stuff.

Sources:

https://en.wikipedia.org/wiki/Brodmann_area_25

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=12999&cn=5

http://psychcentral.com/blog/archives/2006/10/11/area-25-may-help-the-severely-depressed/http://www.medicalnewstoday.com/releases/106460.php

http://www.empowher.com/depression/content/depression-and-brodmann-area-25

http://psychcentral.com/news/2008/06/27/new-study-of-dbs-for-depression/2518.html


Comments (Page 3)
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on Jul 08, 2012

DrJBHL
That really isn't a proven fact... no one has demonstrated a loss of creativity or humor by easing depression...

Yet.

 

Looks like 'mother's little helper' now has batteries included....

on Jul 09, 2012


Quoting DrJBHL, reply 28That really isn't a proven fact... no one has demonstrated a loss of creativity or humor by easing depression...

Yet.

 

Looks like 'mother's little helper' now has batteries included....

Indeed, Mick.

 

Some folks have brain chemistry problems not easily solved... if all else fails, this device might help. Better than sponginging the pavement, and much is gained by easing suffering.

Yet.

That type of argument cannot be answered except with "tincture of time".

on Jul 09, 2012

Doc...not necessarily....not when the incidence of mental 'issues' amongst the creative appears to sit well outside any reasonable bell-curve....

 

on Jul 09, 2012

Jafo - while being an artist can lead to loneliness, the depression rate amongst successful ones (including authors, artists and entertainers) is low. Supposedly.

Perhaps it has to do more with inherited risk (genetics), duration of stress and its severity, and availability of support. 

At any rate, I can't find any 'real' data to look at, only pseudo-scientific studies. The closest to data is http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm#High .

I think we'll have to shelve it until real data based on reliable sampling and criteria is done and analyzed by real statisticians. Otherwise we're dealing with the phenomenon of 'iceberg tips' - famous people get noticed and written about, not the 90% under water, and unseen... Titanic's Captain could elucidate that better than I.

on Jul 09, 2012

Only 'problem' is that some of the world's most 'creative' minds have been depressed and/or suicidal, etc. 'Kill' the 'disease' and bang goes their creative artistry.

Simple test....see if you can list ALL of the British comedians who WEREN'T cronically depressed and/or suicidal....

the same can be said for many US comedians as well....

I've often wondered if the likes of John Cleese, Peter Sellers, Spike Milligan etc... would have swapped their affliction for a normal life... I actually doubt it...

 

Man goes to doctor. Says he's depressed. Says life seems harsh and cruel. Says he feels all alone in a threatening world, where what lies ahead is vague and uncertain. Doctor says the treatment is simple. The great clown Terrifini is in town tonight. Go and see him. That should pick you up. Man bursts into tears: "But doctor . . . I am Terrifini."

The Tears of a Clown:  Comedians & Depression....        

Jim Carrey's battle with depression..

 

interesting read...

I suppose you have the comedians born genetically prone to depression....and those whose depression is bought about by childhood abuse/tragedy.... would Billy Connolly be the comedian he is today if he had had the perfect childhood...     guessing.....nup..

 

on Jul 09, 2012

sydneysiders
Man goes to doctor. Says he's depressed.

Here's some efficiency (G-d bless the man):

Though it might give me a scare to see a Neurosurgeon dressed that way.

 

on Jul 09, 2012

Dr. JBHL...

Since this is device is also controlled by a magnet I wouldn't be able to have it implanted because of the VNS since it is controlled by a magnet. I am curious though... Since my Epilepsy causes a very bad temper and anti depressants are being taken to control it... can this help with the temper of Epilepsy and the depression that comes with MS since I also have MS? Have there been any studies done with this helping people with temper issues involving seizures and depression  involving MS?

on Jul 09, 2012

LizMarr
I take so many darn drugs I have to work to be depressed - or just not take the drugs. Drugs keep me mellow but unwilling to go or do anything in the real world unless chased out. No drugs and I'm manic, depressed, and subject to paranoia and panic attacks. I would give anything to be off the drugs. Being up 24 hours a day leads to a lot of computer productivity, but on the other hand the depression could be a killer and so could the extreme anger coupled with the knowledge of how to really hurt people. So, I'm stuck with drugs. Having a gadget stuck in my head would be far less side effects than the long term effects of the chemicals. Because of my health, I can see both sides all to well.

 

i stopped taking meds years ago... i felt NOTHING... nothing worse than feeling nothing...

cant feel anger, cant feel sadness, cant cry, cant feel happy..just nothing

plus my whole body felt like a wet bag of cement...could barely move..

no thanks....

but i still see the whole bi polar thing as a curse....no matter what. BUT i do try my best to fight it and win over it and thats what matters in the end i guess..

on Jul 09, 2012

I understand all too well going off all the medication because they would knock me out and I would sleep all the time. That includes the seizure drugs. I would then pay the price with another bad grand mal seizure and get badly hurt along with a worse temper and depression and now the MS and depression that goes along with that. I've learned through experience that without the medication a price is paid and it is a very high one.

I always said that I would never have brain surgery to try and take out the seizure focus if they could because if could come back and brain surgery is dangerous. But I have changed my mind and went through it twice to see if I would be a candidate for it. I'm not because that's when they found the MS the second time around in 2008. If I didn't have the VNS... I think I would definitely try for this implant.

on Jul 09, 2012

TheCatsMeowMix
Dr. JBHL...

Since this is device is also controlled by a magnet I wouldn't be able to have it implanted because of the VNS since it is controlled by a magnet. I am curious though... Since my Epilepsy causes a very bad temper and anti depressants are being taken to control it... can this help with the temper of Epilepsy and the depression that comes with MS since I also have MS? Have there been any studies done with this helping people with temper issues involving seizures and depression  involving MS?

I honestly don't know, but it's being used in such a small population at this point I'd be hard pressed to draw any but anecdotal conclusions.

Sorry

Vampothika

Quoting LizMarr, reply 27I take so many darn drugs I have to work to be depressed - or just not take the drugs. Drugs keep me mellow but unwilling to go or do anything in the real world unless chased out. No drugs and I'm manic, depressed, and subject to paranoia and panic attacks. I would give anything to be off the drugs. Being up 24 hours a day leads to a lot of computer productivity, but on the other hand the depression could be a killer and so could the extreme anger coupled with the knowledge of how to really hurt people. So, I'm stuck with drugs. Having a gadget stuck in my head would be far less side effects than the long term effects of the chemicals. Because of my health, I can see both sides all to well.

 

i stopped taking meds years ago... i felt NOTHING... nothing worse than feeling nothing...

cant feel anger, cant feel sadness, cant cry, cant feel happy..just nothing

plus my whole body felt like a wet bag of cement...could barely move..

no thanks....

but i still see the whole bi polar thing as a curse....no matter what. BUT i do try my best to fight it and win over it and thats what matters in the end i guess..

Some meds unfortunately have that effect... since then though, newer ones are around (takes trial to see...) which don't have that type of effect... that said, many bipolar patients resist treatment because the energy they feel when 'up'.

TheCatsMeowMix
I've learned through experience that without the medication a price is paid and it is a very high one.

When such possibly potentiating diseases co-exist, it's very hard to know where symptoms are coming from. I really think you should consult with your Neurologist about this problem, and ask him the questions about whether having two such devices is really a problem or not. The magnetic fields used to program them are nowhere near the strength of MRI signals, and the battery/generators can be placed far apart.

As for brain surgery, Lizmarr... the surgery to remove an epileptic focus can generate a scar which might create an epileptic focus as well.

on Jul 09, 2012

I've had several encounters with depression... today, but shoving wires into my head, although it sometimes seemed like a good idea as any, doesn't seem so appealing when I'm lucid.

 

 

on Jul 09, 2012

unacomm.... no one offered. It's just something to know about if you're ever in a jam, and... don't try this by yourself at home. 

on Jul 09, 2012

ECT (much improved in technique) has been making a quiet comeback and has been proving to be very beneficial in resistant cases.  Still very much under the radar because of its historical (mis)application, depending on how you look at it.  The principal advantage over an implanted device is that future potential need for diagnostic MRI is not impacted.

on Jul 09, 2012

ECT (much improved in technique) has been making a quiet comeback and has been proving to be very beneficial in resistant cases.  Still very much under the radar because of its historical (mis)application, depending on how you look at it.  The principal advantage over an implanted device is that future potential need for diagnostic MRI is not impacted.

Also correct. Also true re: CT. The DBS should really only be used for ECT resistant cases or those for whom another medical condition presents a contra-indication or is unacceptable for some other reason. 

on Jul 09, 2012

DrJBHL
1. It changes the brain chemistry using electricity - just like the brain (and any tissue which maintains a potential difference does).

2. It does not "force" anything. Depression "forces" problems. The patient isn't turned into a grinning idiot.

3. About EMR? If strong enough, it will cook anyone with or without a medical device.

 

1. No, it changes it differently to how the brain does it. If brain cells are shocking each other you have a serious case of Myelin decay. Nerve cells communicate via chemicals in the synapse. Electrical impulses are used WITHIN individual cells through the Axon.

https://upload.wikimedia.org/wikipedia/commons/a/a9/Complete_neuron_cell_diagram_en.svg

https://en.wikipedia.org/wiki/Axon

2. It does force things, I explained what. Depression is harmful, yes, if only this solved depression. Strawman argument about the grinning idiot.

3. IF strong enough it will vaporize a city (99% of the energy released by nuclear bomb is EMR which rapidly converts to heat as it contacts the air and solids around the epicenter; if exploded in low orbit it instead converts into an EMP).

But you are more keen to throw hyperboles then actually discuss an issue.

4. Nice picking and choosing, but this will simply not work effectively.

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