Beyond Blue

I mentioned Deep Brain Stimulation (DBS) the other day, but the link to the article on it required a password. Sorry about that.

Here are some excerpts from an interview with Helen S. Mayberg, M.D., professor of psychiatry and neurology at Emory University School of Medicine that appeared in the Fall 2006 issue of Johns Hopkins’s Depression and Anxiety Bulletin. Mayberg’s recent study using deep brain stimulation to successfully treat severe treatment-resistant depression (published with Drs. Andres Lozano and Sidney Kennedy at the University of Toronto) has generated international interest. It provides hope for people like reader Nancy, who haven’t found any relief in medication, cognitive-behavioral therapy, or even electroconvulsive therapy (ECT):

Q. What does the electrical current generated by DBS actually do to the brain?

It’s a circuit-board approach; we’re resetting the way a brain system is communicating.

You can think of DBS as a means of restoring normal channels of communication in the brain where it has tended toward a faulty pattern when left to its own devises. We’re rerouting the system with electrical impulses generated by the surgically implanted stimulator.

The net effect we’re seeing is not only a resolution of depressive symptoms (and, in many patients, clinical remission), but also an impact on how patients subsequently handle day-to-day stress. The improvement in stress management is not because of blunted emotions; the patients feel normal highs and lows. Rather, they seem to get through the bad stuff with greater resilience.

Q. Can you explain the circuit-board approach to depression?

You can think of “circuits” as the connection between specific sets of nerve cells in different regions of the brain. In many ways, this is a standard neurological approach—looking to define the brain wiring in regions involved in depression. Advances in functional neuroimaging methods, starting with PET and now expanding to functional MRI (fMRI), have made the brain mapping of mental illness possible. This strategy is different from–but complementary to–that taken by a pharmacologist, as it adds the specific “where” in the brain, not just which chemical.

Pharmacologists can think about chemistry in the brain without the need to concern themselves with “where.” This is because antidepressant medications bathe the entire brain in chemicals; they do not deliver chemicals to a particular spot. But for neurologists and imagining experts, “where” is often the primary starting point. It doesn’t supersede the chemistry, but it tries to understand the chemistry in its anatomical context.

Q. How do psychiatrists react to this neurological perspective?

Nobody likes change, but historically neurology and psychiatry were a single discipline; we’re just moving back to that. Freud was a neurologist; he just didn’t have the tools we have today. The world would be a different place if Freud had a PET scanner.

It’s all about evidence-based progress. Imagining research has confirmed that depression is, first and foremost, a brain disease. I don’t see any dissonance between psychiatry and neurology on that point. We’ve simply come to realize that the ways we’ve been looking at depression are not good enough. We all see that we need to learn something new about the disease and combine our perspectives.

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