Ruminations

Treating Depression

"This is not a pill, it's a surgical procedure, so there's much more variability in the surgical procedure than there is in taking a simple medicine."
"[DBS -- deep brain stimulation refers to] stimulation [but it is an inhibitory effect at work]."
Dr. Andres Lozano, neurosurgeon, Toronto Western Hospital

"Recovery is actually a very long process. It's not like you just wake up one morning and your depression is gone and your life is wonderful."
"Seeing those blazing reds, intense yellows and oranges in a way that I hadn't seen in years, I started to sob right in that parking lot [in recovery from 19 years of debilitating depression]."
Kathryn, profound depression sufferer

"These people need to learn how to rebuild their lives and undo past ways of connecting with others. The people who successfully do that, you can see that they're able to go back to work. Their remission rates creep up over one to three years."
"DBS is a long-term prospect. We work with these people for 15 years -- or more. You get 'married' to them in some ways, it's 'till device or death do you part."
Dr. Peter Giacobbe, Toronto psychiatrist, University Health Network

Kathryn, whose last name has been withheld for privacy reasons, describes the kind of severe depression she has suffered as insidious, a condition she doesn't recognize as intense sadness but rather as a numbing effect causing an inability to feel anything whatever. And according to the World Health Organization, the leading cause of worldwide disability is depression.

One third of people with depression fail to respond to trials of multiple medications and treatment, including psychotherapy and electroconvulsive therapy. It took two years, two months and five days for Kathryn to realize her senses had returned "back online", once she had undergone experimental brain surgery identified as DBS, deep brain stimulation.

DBS is an experimental therapy, a treatment reserved for the most severe type of depression that people experience. The U.S. Food and Drug Administration is awaiting the results of clinical trails that demonstrate DBS's safety and effectiveness to fight chronic cases of treatment-resistant depression before it will approve the therapy.

It was 2003 when researchers began experimenting with DBS. A procedure which calls for a surgeon to drill a small hole into the skull to be enabled to direct an electrode down into a region called Brodmann area 25 -- identified by a leader in the field of DBS, Dr. Lozano, as the 'sadness centre of the brain'.

A standard DBS device

The opposite end of the electrode tunnels down under the skin to a battery, a peacemaker-like device implanted in the chest. Doctors use a remote control to turn up or down the amount of electricity delivered to that specific area of the brain. The current from the electrodes turn down sadness; pumping the brakes, in effect. It is a form of therapy meant for people unresponsive to medication or psychotherapy.

This is no cure, unfortunately; once stimulation stops, depression returns. But because Kathryn underwent DBS therapy she no longer takes medication and there have been no residual symptoms of depression, nor has she experienced any adverse effects due to DBS. Before undergoing DBS surgery 40 different medications had been tried, along with electroconvulsive therapy and psychotherapy.

None worked, and Kathryn contemplated suicide, more than once. DBS was, in effect, her last hope to recover some semblance of normalcy and leave mind-numbing depression behind. She happens to be one of those for whom DBS has been successful. And, as with any other kind of remedial surgery, another step followed; therapy, for patients post-DBS to learn how they can rebuild their lives.