Brain Stimulation for Treatment Resistant Depression

A new research study confirms that deep brain stimulation (DBS) is a potentially effective treatment option for people with treatment resistant major depression.

Researchers from the Cleveland Clinic, Brown University, and Massachusetts General Hospital were inspired by the success of DBS in treating the tremors associated with Parkinson’s and movement disorders like dystonia and essential tremor.

“Starting in 2001, we began treating patients with obsessive compulsive disorder (OCD) with promising outcomes. These findings resulted in the initiation of a subsequent trial for patients with severe and medication intractable major depression, starting in 2003,” stated Dr. Ali R. Rezai, MD, director of Cleveland Clinic’s Center for Neurological Restoration.

The World Health Organization rates major depression as the top cause of disability worldwide. While many patients with major depression find relief through a combination of psychotherapy and medication, some people are left severely disabled.

Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.

DBS surgery involves the placement of tiny implantable electrodes into specific parts of the brain that are functioning abnormally. These electrodes emit tiny pulses of electrical stimulation to block the abnormal activity in the brain, which causes a variety of symptoms – such as pain, tremors, movement problems; as well as obsessions, moods and anxieties associated with psychiatric disorders.

The success of DBS is dependent on the surgical team’s ability to precisely pinpoint the specific brain area for stimulation. The advantage of DBS is that it is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation.

“The preliminary results of research undertaken between 2003 and 2005 indicated that bilateral DBS of the anterior limb of the internal capsule holds promise for the treatment of intractable major depression, which led to the more extensive research results being presented today,” added Dr. Rezai.

Fifteen chronic and severely depressed patients were enrolled in this study. These patients had failed multiple medication trials, as well as psychotherapy and electroconvulsive therapy (ECT). These highly intractable and often suicidal patients underwent bilateral DBS implantation in the ventral internal capsule/ventral striatum (VC/VS) at the three institutions.

The following outcomes were noted:

• Responses were seen in seven (47 percent) of 15 patients at six months, five (45.5 percent) of 11 at 12 months, and eight (53.3 percent) of 15 at last follow-up.
• Long-term improvement in depression severity, functioning, and quality of life were all noted.
• Measures of short-term memory improved.
• There were no hemorrhages, infections or other neurological deficits.

“This research substantiates our earlier findings, which indicate that bilateral DBS of the anterior limb of the internal capsule holds promise and hope for select patients suffering from severe and treatment resistant major depression, stated Dr. Rezai.

“While about half of this patient group responded to treatment, I feel that as we learn more about this rather new technology, efficacy will continue to improve. It is important to understand that this treatment is not for everyone with major depression and only for those that have tried various medications, psychotherapy and ECT. But, nevertheless, it is very promising news for the many suffering patients and their family members that have virtually given up hope.”

Source: American Association of Neurological Surgeons (AANS)

Shaking my fist at diabetes

The point was driven home today that diabetes is a bigger threat to me right now than nineteen years of HIV/AIDS. I’ve heard it before and frankly, despite taking blood glucose-lowering medications, I just haven’t managed to get the crucial numbers under control.  Things went off the rails this time last year, with Craig’s accident and death, [...] (Source: My journey with AIDS)

Book Review of Madness: A Bipolar Life

Madness, by Marya Hornbacher, is one of the few personal accounts of bipolar disorder I’ve read that covers the escalating unfolding of the disorder from such an early age (4 years old) to the present. The book covers just about every aspect of the struggle with bipolar disorder – early failures to diagnose it, misdiagnosis, clueless and competent psychiatrists and therapists, stressors, triggers, the tendency to self-medicate, hospitalizations, hyper-sexuality, the terrible side effects of many of the medications used to treat depression and mania, bipolar and career, alcoholism, self-mutilation, relationship dynamics, lack of insight (not realizing when a manic episode is settling in), and the highly productive and invigorating hypomanias that often convince those with bipolar disorder that nothing’s wrong. Her narrative functions almost like a textbook case study of bipolar disorder. (more…)

Beware of Commercial Tests for Mental Disorders

The unraveling of the human genome has lead to advances in determining genetic risk profiles for particular illnesses. Perhaps the best known and scientifically credible discovery is the link between the BRCA genes and the development of breast cancer.

However, when it come to assessing the risk of developing mental conditions such as bipolar, the genes responsible for most brain disorders remain unknown. Nevertheless, commercial genetic tests are now available that claim to assess your risk of developing bipolar disorder. Genetic tests for major depression and schizophrenia are also expected to reach the market soon.

The May issue of the Harvard Health Letter elaborates on the controversy.

According to the Harvard experts, one problem is that the genetics field is advancing so rapidly that it’s hard to keep up with developments, never mind figure out which ones are clinically relevant.

Most authorities also believe that psychiatric disorders develop because of the interplay between multiple genes, each exerting small effects. That makes finding the responsible genes harder. Further complicating matters, research has revealed that many healthy relatives of people with psychiatric disorders have risk genes.

Whether a person develops an illness depends on unknown ways the risk genes interact with other genes and environmental factors.

Scientists have identified perhaps thousands of candidate genes that may contribute to psychiatric conditions. But experts continue to debate which genes are actually involved. Most candidate genes fail to hold up—meaning that the association between the gene and a given illness disappears when scientists try to replicate the results. One analysis estimated that 70% to 80% of candidate genes are false positives.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, notes that someday it may be possible to reliably assess risk for psychiatric disorders. But at this point, the technology—and the science—is still evolving.

Source: Harvard Mental Health Letter

Smoking Ups Risk of Depression

A new observational research study discovers a strong relationship between smoking and depression and that the risk of depression (and tobacco use) is tied to genetic and environmental influences.

In the investigation, scientists from the University of Navarra, in collaboration with the University of Las Palmas de Gran Canaria and the Harvard School of Public Health (USA) followed 8,556 subjects to determine the relationship between tobacco use and depression.

They found the risk of suffering depression increases 41 percent in smokers, in comparison with non-smokers.

The article, whose first author is Prof. Almudena Sánchez-Villegas, is based on research undertaken over the course of 6 years on university graduates with an average age of 42.

“Over the course of the tracking and data collection stage, 190 smokers who initially did not present depression were diagnosed with this disease by a doctor. In addition, 65 who were not diagnosed indicated that they were taking antidepressants during this period,” indicated Miguel Ángel Martínez-González, director of the research project and Chair Professor of the Department of Preventive Medicine and Public Health.

Among the mechanisms that shed light on this relationship, he points to “genetic and/or environmental disposition, which will increase the probability that the tobacco habit is retained and that the user will suffer depression as an independent issue.”

Lessening of Physical Activity

Investigators found an increase in tobacco use was correlated with a lessening of physical activity in the smoker’s free time. A finding that will benefit from additional research to ascertain directionality of the exposure.

Another interesting finding was that those who had given up tobacco more than a decade previously had a lesser probability of developing depression than those who never smoked.

In summary, researchers conclude that additional studies are indicated to clarify and determine the mechanisms that cause the associations as well as potential interventions to mitigate the risk of depression.

Source: University of Navarra

Mood Lighting for Gaming

In the mental health blogosphere this week my favourite post came from Dr. Shock, in a post that is part of the cool Research Blogging initiative. He reported on a new paper published in Cyberpsychology & Behavior called Lighting in Digital Game Worlds: Effects on Affect and Play Performance, by Igor Knez and Simon Niedenthal.

Lighting has been shown to have effects on mood in the physical world (both sunlight and artificial light; see lots of info on the subject). Blue light, as is found in fluorescent light tubes, has been linked to cognitive arousal (on the upside) as well as insomnia, hormonal disruptions and cancer (on the downside). The decline in the intensity of light can lead to Seasonal Affective Disorder (SAD) and blue/green and full-spectrum light are used in phototherapy, an effective cure for winter depression.

On the flipside, amber and red light can be used to block out blue light to help relieve insomnia and overstimulation. The relaxing effects–tones that mimic light from candle flames–apparently have benefits in virtual game worlds as well. 38 people played Half Life 2 in maze sequences using different lighting conditions: neutral gray, cool (bluish) and warm (reddish). In the warm light they felt “happier and gladder, more enthusiastic and peppy” to a significant number. “According to the results, the participants performed best and fastest in the warm lighting, and they felt significantly more pleasant in that condition.”

Dr. Shock quips:

These results are important for game designers and developers of online communities and visual worlds. Nevertheless maybe in the future also for indoor lighting and even depression considering the effects on mood. Wouldn’t it be nice when suffering from depression and being treated with computer games three times a day?

However, it seems that skill and confidence might have had an even bigger effect: “…medium- and high-skilled players felt calmer and more relaxed than the low-skilled players did, independently of the lighting.” The authors note that a digital gaming environment is a complex artifact with many factors involved, but the study is a step forward for design.

Read more.

Knez, I., Niedenthal, S. (2008). Lighting in Digital Game Worlds: Effects on Affect and Play Performance. CyberPsychology & Behavior, 11(2), 129-137. DOI: 10.1089/cpb.2007.0006

BPN 35: Email and Still Nobody Likes You

In this episode Joe covers some emails and continues his discussion on family difficulties. Next time will bring a new subject, we promise!

Best Of BPN: Episode 5 Encore Presentation

This is an encore presentation of Episode 5. Enjoy!

Patient mental illness in a dental school clinic

Self-reported mental illness in a dental school clinic population The purpose of this study is to assess the prevalence of mental illness in a university-based dental clinic population. Dentists routinely review the patient’s medical history to identify any physical disease or condition that may impact dental treatment. Mental illness may also affect dental treatment and patient management. This study examined the degree to which patients seeking routine dental care report these diagnoses. Data was gathered from records of 508 consecutive new patients whose treatment plans were submitted for faculty approval. The patient’s self-reported mental illness was obtained from the patient questionnaire and physical evaluation forms of the dental record. One hundred thirty-six patients (27%) reported at least one mental illness. Of all diseases and disorders recorded in the medical history, self-reported depression was second only to hypertension in frequency. Substance abuse (alcoholism, addiction, medication), anxiety, anorexia, bulimia, insomnia, bipolar disorder, and post-traumatic stress disorder (PTSD) were also common findings. This study establishes the need for training of dental students to recognize and manage psychologically compromised patients. The dental curriculum must address these issues. J Dent Educ. 2003 May;67(5):500-4. Self-reported mental illness in a dental school clinic population. Woods CD. See also; Brief-TSF can assist patients cease alcohol consumption. Twelve Step Facilitation Subscribe to Twelve Step Facilitation by e-Mail           Relapse Prevention Counseling Workbook: Managing High-Risk Situationsby Terence T. Gorski Read more about this title… Brief-TSF manual US$9.95 Buy Now with Paypal, Visa or Mastercard Subscribe to Twelve Step Facilitation by Email (Source: Twelve Step Facilitation.com)

Omega-3s Uncertain for Bipolar

A new review of existing studies finds that there is still not enough evidence to say whether omega-3s are useful treatments for people with bipolar disorder. The summary comes despite intriguing findings that omega-3 fatty acid supplements could alleviate depression symptoms.

Nevertheless, omega-3s deserve further study, since they seem to have no serious side effects and most experts recommend the supplements for people with heart disease and some immune disorders, said authors Paul Montgomery, Ph.D., and Alex Richardson, Ph.D., of the University of Oxford.

Montgomery and Richardson found five studies on the effects of omega-3 supplements for bipolar disorder, but only one study of 75 patients provided enough data on the therapy’s outcomes for the researchers to analyze. Patients in the study had less severe depression symptoms while taking the supplements, but omega-3s did not affect their mania symptoms. Patients with bipolar disorder can cycle between periods of mania — elevated mood and energy — and depression.

The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Montgomery said the review makes it clear that there is not enough evidence yet to determine how omega-3s affect bipolar disorder, “and what evidence is currently available is of such a varied and oftentimes questionable nature that no reliable conclusions may be drawn.”

Bipolar disorder is among the top 30 causes of disability worldwide. Clinicians prescribe a variety of mood-stabilizing drugs to treat the complex psychiatric disorder, but the medications rarely cause symptoms to disappear completely and they can have serious side effects.

Recently, a growing handful of studies have suggested that omega-3s can be beneficial for other mood disturbance disorders such as clinical depression, personality disorders and schizophrenia.

Different versions of the fatty acids are in vegetable oils such as flax seed oil and in fish oils. Researchers are still not clear how omega-3s work in the body, but they might “play key roles in brain structure and function,” Montgomery said.

For the moment, the few studies available suggest that patients should use omega-3s along with prescribed mood stabilizers, Montgomery said.

Joseph Hibbeln, M.D., who heads the nutritional neurochemistry division of the National Institute on Alcohol Abuse and Alcoholism, said he and his colleagues “strongly recommend” that patients with psychiatric disorders not take omega-3 supplements “in lieu of established psychiatric treatment options.”

Companies that manufacture the supplements, along with government and charity funding, supported some of the studies considered for the review. Montgomery and Richardson have worked as consultants to several fatty acid supplement companies, the review disclosed.

Source: Health Behavior News Service

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