Brain implant provided immediate relief to a severely depressed patient

My partner is defending her PhD on using Deep Brain Stimulation (DBS) i.e. a comparable device with constant current, to address severe OCD next Friday. Results are impressive (and published) on a small sample of ten patients. There’s at least three research programs that I know of (and probably a couple more if I had read the bibliography properly rather than just fix the formatting issues) with a dozen patients, some for OCD, other for other psychiatric issues. The approach is widely effective on neurological issues (Parkinson’s notably).

Her lab have scheduled double-blind trials as soon as the next patient is operated, which I think is next month, with a protocol that includes 1. implanting the device, 2. only activating the electric current for half for six months, and 3. have another psychiatrist, blinded to whether the device is active, test its effect.

There was an ethical debate on testing the device without Cognitive behavioural therapy (CBT) at the same time: CBT has a meaningful impact, and no doctor would imagine not prescribing that too, but scientifically, having patients with and without CBT, with and without DBS, etc. would allows to measure the effect of the each alone and together.

I learned about this seemingly different approach (I suspect the device is similar, but the current is triggered differently, from the vulgarisation — haven’t read the academic papers) recently, but I’d be surprised if most of the protocols didn’t extend without much complications.

> Impossible that it would receive ethical approval

> The fact the patient knows she has a myriad of doctors looking at her, and that she had to undergo an extremely invasive and unique procedure means we cannot separate the intervention from the response.

Deep brain stimulation has undergone many such trials[1]. I'm not sure why this would be such an ethical barrier when we have much more risky and permanent procedures (various surgeries, for example) that can undergo ethical trials.

Methodology summary from trial linked below:

"We conducted a 6-month double-blind, randomized, sham-controlled crossover study in implanted patients with previous severe TRD who experienced full remission after chronic stimulation. After more than 3 months of stable remission, patients were randomly assigned to 2 treatment arms: the ON-OFF arm, which involved active electrode stimulation for 3 months followed by sham stimulation for 3 months, and the OFF-ON arm, which involved sham stimulation for 3 months followed by active stimulation for 3 months."

1. https://pubmed.ncbi.nlm.nih.gov/25652752/

typically this is done via sham stim. i.e. implant both groups, but don't turn on the control group for the blinded phase. Helps that DBS technique has had 40 years or so to refine itself so its adverse-effect rate is reasonably well known and established.

See methods section https://n.neurology.org/content/88/16_Supplement/P5.016

There are animal models for depression.

I wish the field of psychiatry was mature and used different words for depression caused by your environment and life stressors vs depression caused by brain chemistry vs depression caused by ignoring nutrition. It's not fair to compare these types of depression as worse or less worse and each would need different kinds of treatment protocols. The current definition is just based on symptoms and trying therapy and medication until something works.

There is a lot of promising research being done about the relationship between your gut microbiome and depression and other mental health issues.

Hopefully more research is done in populations across the world because it seems like currently most of the literature is focused on a western population.

"High-fat consumption not only leads to obesity but also causes widespread inflammation of body systems. The gut microbiome may alter the harmful effects of the high-fat diet, improving mood and behavior. By modulating gut microbiome composition through proper nutrition and probiotics, we also help decrease anxiety and depression [4]." [0]

[0] (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510518/

[4] (2018) https://www.sciencedirect.com/science/article/pii/S088915911...

The way I think about it is that there are a number of conditions that can cause serious depression, some of which are known and have a straight-forward treatment, for instance, thyroid and hormonal issues, certain sleeping disorders, and certain nutrition issues.

If the cause of the mental issues is unknown, you're left with treating the symptoms, which is certainly better than nothing, but often inexact and trial and error. Thus it makes sense to knock out any probable known causes when starting treatment before assuming an unknown cause.

My personal experience was when I was first diagnosed is that I had my vitamin levels checked, thyroid checked, had some sleep labs, and everyone recommended losing weight and exercise.

You're right, but depression is so tricky. It can help to treat the symptoms short term, which can enable you to treat the root cause long term.

Did your problems get solved by eliminating certain foods and if so, how did you go about narrowing down the culprits?

One problem with depression, as mentioned in the article, is that it's hard to define exactly what the problem is (there's no "depression center" in the brain) which means treating the symptoms is often the only option.

> [..] abused to make them also complacent, obedient, work twice with half the pay without complaining and buy the highest bidding brand.

Not to worry, the new brain implant provides immediate relief from negative feelings about the brain implant! You'll be hysterically cackling in no time on your way to work at your third minimum wage job in the mines, with a protein snack made of an assortment of bugs.

In all seriousness, this is highly concerning, especially in conjunction with the powers that have been given so easily during the COVID pandemic.

Imagine in 10 years time it is declared that there is a 'depression pandemic', and for the better health of yourself and those around you, you must get your anti-depression implant in order to return back to work, and without your implant passport you will not be allowed into bars, restaurants, etc. Those that have already had the implant call you 'anti-Science' and publicly ridicule you as a second-class citizen. The President at the time publicly declares "our patience is running thin", as pressure ramps up to combat yet another infectious wave of depression.

The government promises "the implant will only be used to track and trace contact with those suspected of having depression", but soon the police realise that such technology could also be used in "exceptional" criminal cases, where your state of mind around the place of the crime can be submitted as evidence to your involvement. Once there is some acceptance and legal standing, the use becomes more and more common place. Eventually some smart people realize that there is some pattern of behaviour for people who are about to commit a crime, and so pre-crime arrests and thought-crimes arise.

The future has never looked so safe!

We can't. Depression is your brain's reaction to not being able to pick and maintain long-term goals for prolonged time. And the increased number of depressed people in the past decades is an indication that something about our society is going wrong.

Dealing with it without resolving the underlying cause is effectively turning people into obedient work force that has accepted its fate.

Eh, sorry. We probably could have, but you just gave me all these great ideas.

Then again, if I’ve learned anything from the past decade, forget all that working harder stuff, I’ll just figure put how to sell advertising straight into your brain implant, don’t mind me while I take some of the most talented programmers in the world to do this.

Microdosing taser shots to your brain, just hustle and grind things

I think you will like this

https://qualiacomputing.com/2016/08/20/wireheading_done_righ...

I don't think deep brain stimulation is that sophisticated, so you probably don't need to worry about it right now.

Fortunately, or unfortunately depending on how you view it, brains don't seem to work like that.

The likelihood of DBS being able to turn someone into an ideal worker/consumer is about the same as it being able to turn a Parkinson's patient into an Olympic athlete.

Getting on better with your associate employee contemporaries. At ease.

Is this supposed to be an argument against the development of technology?

Any technology can be used for ill or good, we just have to hold people accountable.

Not sure what you would expect the device to do expect help people with depression.

The US prison system is a horrible blight, but this really has nothing to do with it.

Lol, why wouldn't they do it now and give them pacifying medication?

The article indicates that previously she was unable to care for herself. While not exactly fully objective, i feel like - do you need someone else to take care of you, is not a purely subjective measure.

We have some measures like PHQ-9, QIDS, and MADRS.

https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

https://www.mdcalc.com/quick-inventory-depressive-symptomato...

Cognitive Therapy has made depression "objective" and even provided a reliable diagnostic tool for it that even a layman can use it - https://therapydave.com/docs/burns-depression-checklist.pdf ...

Also if n=1 then it could just be a placebo, no?

Indeed: https://en.wikipedia.org/wiki/The_Terminal_Man

“At that moment, when I had the TV sound off, I was in a 382 mood; I had just dialed it. So although I heard the emptiness intellectually, I didn't feel it. My first reaction consisted of being grateful that we could afford a Penfield mood organ. But then I realized how unhealthy it was, sensing the absence of life, not just in this building but everywhere, and not reacting—do you see? I guess you don't. But that used to be considered a sign of mental illness; they called it 'absence of appropriate affect.' So I left the TV sound off and I sat down at my mood organ and I experimented. And I finally found a setting for despair. So I put it on my schedule for twice a month; I think that's a reasonable amount of time to feel hopeless about everything, about staying here on Earth after everybody who's smart has emigrated, don't you think?”

― Philip K. Dick, Do Androids Dream of Electric Sheep?

I would absolutely use it. The current state of mental health care feels like the wild west at times. I want to imagine a technology like this would have less side effects than what we currently use.

I don't know where we would have to draw a line for when to use it. When you miss the bus and were late to an important meeting. When you lost a pair of your favorite headphones. When you lost something you feel very sentimental about. When you lose a pet or a loved one. When you see something traumatic. When you experience something traumatic.

What would feeling down mean in a world where happiness is a click of a button away?

> I’m imagining an app on your phone where on a day you’re feeling down, you turn it on for a bit.

That’s not really what this brain implant does. The patient was experiencing certain obsessive thought loops leading to depression. The brain implant was targeting at disrupting the thought loops allowing for recovery.

A brain implant that directly induced positive mood would be something else entirely. I suspect it could quickly lead to addictive behaviors as patients give up on naturally improving their condition and learn to rely on pressing the button for more happy thoughts instead.

Nope.

When I was a student maybe 5-10 years ago, I got to attend a conference on brain/computer interface research as part of an extracurricular.

There were lots of interesting posters and products, but what really grabbed me was one of the headlining presentations. A group of researchers had learned how to use deep brain stimulation to do exactly this: provide immediate relief to a severely depressed patient.

The video was dramatic, but I found it creepy. One second, the person looked sunk in misery as they talked about their bleak outlook on the world. The next second, they started smiling and saying that everything seemed alright. The on/off procedure repeated a few times with the same effect: misery, relief, misery, relief.

I would take a brain implant to help me type faster, or treat a degenerative brain disease. But something that acted like a rapid mood-altering drug? Never, not after seeing that video.

To quote G'Kar: "we are all the sum of our tears. Too little and the ground is not fertile and nothing can grow there. Too much, the best of us is washed away."

The problem with using such a device at will when merely feeling down (that is, things that are not clinical depression) is that life will become boring, monotonous, and in a way, almost futile. What's the point of anything any more if we can just "be happy" at the press of a button? Why bother actually solving whatever made you unhappy in the first place? How can you still appreciate the good moments? How can you still build deep social relationships if your ability to make someone else happy? (Or why even seek out such relationships in the first place?)

Occasional use won't be a huge problem, but such a device would quickly become addictive at least psychologically, if not psychically. It's impossible to say what will happen, but I don't think it will be very positive.

So my answer would be "no".

Aside: the idea is not entirely new; e.g. in Brave New World there is a "happy drug" with more or less the same effects that you describe.

> The zapping a brain with electrodes, sounds liked a more selective way of using ECT.

This method is entirely different than ECT. The researchers used an electrode to disrupt specific ruminative thoughts that were causing, or at least perpetuating, the patient’s depression.

It’s more analogous to traditional therapy methods applied by brute force at the physical level. Whereas traditional therapy would train patients to identify and break negative thoughts loops, this patient was apparently unable to do so. The brain implant physically disrupts part of the brain that contributes to those loops, opening the door for recovery from the self-defeating process.