Deep brain stimulation for depression

[jono2313]

when you decide iplant is right for you under the above operation and buy ur own medtronic N'vision clinician programmer then program the simulator own to your motivational needs or maybe for some extra dopamine on a Friday night, sure beets coke or beer aye

[J4N15]

How soon would this be available to the general public? I suffer from severe incurable depression and I am looking for any way out of this black hole. I would even be interested in being a guinea pig for researchers, as my insurance would probably consider this "experimental" for the next decade or so and refuse to cover it...

[iPlantChannel]

@J4N15 deep brain stimulation for depression is still in clinical trials. if you're in the US you can search on clinicaltrials dot gov and see if there's one you can join. I expect the procedure to be CE and FDA approved within 5 years, possibly 3. the further elaboration I talk about in the video - the use of DBS to motivate specific behaviours - will take longer, as it's not yet in human clinical trials: my guess is it might be available to a fairly wide range of people by 2015-2017.

[J4N15]

@iPlantChannel Thank you very much for the information and the site. Hopefully I can be accepted into one of the studies on there.

[Chriscom28]

What will this mean for free will.

[iPlantChannel]

@Chriscom28 Very good question. I would argue that if used right an iPlant enhances the free will of its user, as it allows him or her to better carry out intentions and plans. This conclusion requires a neuroscientific account of free will - best described by in 'Brembs (2010) Towards a scientific concept of free will as a biological trait'.

[Chriscom28]

@iPlantChannel Interesting response. I suppose if you really want to take up running, but can't get off your lazy ass often enough you could use the implant to provide reward youself when you do, thus reinforcing behaviour. If the device is under the control of the user then it reslly can't violate free will as you chosen to do it. Though what is the chance that someone else could gain control of the device. Interesting essay you mentioned, will have to read sometime.

[iPlantChannel]

@Chriscom28 well, presumably there will be a rather narrow range of behaviours that have been clinically tested and approved for artificial motivation. the possibility for abuse should be as small as possible. there's more information on this in the safety and ethics section of the iPlant website.

[caketheory]

Ok could you please respond to the user "jockmclaren47" who wrote a comment yesterday.

If you click on his user name and look at his website he's written his objections to deep brain stimulation on his website too.

[iPlantChannel]

@caketheory done, thanks for reminding me.

[caketheory]

@iPlantChannel Also on the one hand your saying it would only be used as a last resort but when someone goes on your website your giving the impression that DBS could be used in a wide variety of settings. For example "motivation, mood, learning and creativity" almost like you want to hand them out like candy.

Also on 3mins 53 seconds of your video you said "its an opportunity for billions of people". There's only six and half billion people on the planet, so what do you mean by this?

[iPlantChannel]

@caketheory my bad, I thought you wanted to talk about currently available DBS treatments. these are always last resort. my videos and website discuss the iPlant - a specific form of DBS (conditional rewarding brain stimulation) that I think will eventually be made available to large numbers of people, but which has not yet been developed for humans. I don't think of iPlants as primarily treating complex psychiatric conditions though - they are simply about motivating beneficial behaviours.

[jockmclaren47]

This is one of the maddest videos I've ever seen. No government could be trusted with this technology (it's been around forever, we had rats with these implants in psychology class in 1967). Who would get it? It would be like Ritalin, urged on parents by lazy schoolteachers, part of a probation order, silly people demanding it because they can't afford a Porsche. Depression is a reaction to life events. Just try talking to the person and find out what the cause it.

[iPlantChannel]

@jockmclaren47 treatments involving DBS for depression are still in clinical trials so the rules are developing. if they end up similar to those for OCD then the patient would have to be a non-responder to at least four other treatments (including talk therapy) before he or she could qualify for DBS. the treatment would have to become much much safer and cheaper before it could be used in the situations you mention. the iPlant website discusses some of what could and should happen at that point.

[jockmclaren47]

@iPlantChannel I've heard it all before. It is based on an unarticulated perception of mental disorder as brain disorder. Depression is the reaction to adverse life events. It is the duty of the psychiatrist to determine those events and deal with them, not cut, cook, shock, fry, drug or otherwise stupefy the human brain. Orthodox psychiatry constantly comes up with these lunatic schemes (and I know the history well) just because it has no model of mental disorder. What these people (cont)

[jockmclaren47]

@iPlantChannel are proposing is not science, it is pseudoscience. Yes, patients will stop complaining but that can be achieved much cheaper and safer with morphine. The woman on the DBS video had a chronic anxiety state, any clown could see that, but the adventurers with the brain probes didn't know how to take a history and engage her in real therapy (and 'talk therapy' is not real therapy). Also, how much money is being spent on this program, when therapy is unfunded? It's dangerous crap.

[iPlantChannel]

@jockmclaren47 I think we'll have to agree to disagree. I'm impressed by the progress that's been made in DBS for psychiatric conditions in the last decade. I also think the next few decades will see much more sophisticated theory and technology developed. I think it's important that we talk about where these developments might take us. your dismissing DBS by equating it with lobotomy really doesn't address the developing state of DBS research, which is what I'm hoping to talk about.

[jockmclaren47]

@iPlantChannel My complaint is that these people do not have a theory of mental disorder guiding them. They have taken an old notion ("pleasure centres") and mated it to modern technology and now they are claiming a "breakthrough." It is essential to know the history of these moves, I am old enough to remember leucotomies and insulin sub-coma treatment. Without a theory of mental disorder (and reductionism is not one), there can only be blind poking.

[iPlantChannel]

@jockmclaren47 Neurobiological theories of mental disorder are ideed immature and I'm sympathetic to therapies that try to get to the root of distressing life events, but your assertion that DBS researchers are merely rehashing old pleasure centre theories is incorrect; the theories are much more complex these days, and I hope you will engage in a discussion about CURRENT (and future) DBS theory and not hark back to outdated ideas like leucotomy and insulin sub-coma treatment.

[jockmclaren47]

@iPlantChannel If you believe these people have an articulated, agreed, published scientific model of mental disorder to guide their practice, their teaching and their research, then could you please name it and give three seminal references. If you can't do that (and I know you can't), then I rest my case: this is another case of blind poking in the brain and no amount of high-sounding technobabble will hide that fact. I repeat: they are adventurers with no map.

[iPlantChannel]

@jockmclaren47 which disorder do you want references for? the theories are different. do you want to talk about the medical basis for DBS to treat depression, for DBS to treat OCD, or for human use of conditional rewarding brain stimulation? there are a lot more than three seminal publications on each (I link to some of them on the 'implant technology' section of the iPlant website). there is also a lot of controversy and debate.

[jockmclaren47]

@iPlantChannel And I thank you. It is the hallmark of non-science that there is no agreement over what constitutes the theory of the subject in hand. The idea of competing theories for the same topic is nonsensical. That is why I can state with no fear of rebuttal that what those people are doing is not science but is another example of pseudoscience which will drag the name of psychiatry deeper in the mud. Ask them yourself: What is your theory of mental disorder. They won't answer.

[iPlantChannel]

@jockmclaren47 first, which mental disorder do you want to discuss? contemporary medical science concerns itself with specific disorders. second, scientific research consists of theories that compete in terms of the amount evidence that can be accumulated in their favour.

[jockmclaren47]

@iPlantChannel I am perfectly well aware of the deficiencies of the application of biological reductionism to mental disorder, seeing as I was about the first in the world to write about them. There is no such thing as a science of mental disorder that has a "theory" for every disorder. That is nonsensical. Name your over-arching theory of mental disorder or accept that DBS is just electronic heroin.

[iPlantChannel]

@jockmclaren47 you have to specify WHICH mental disorder you want to discuss - there are SPECIFIC neurobiological theories for most of them, certainly for those that have DBS as a treatment option. let's talk about anxiety/depression: the dominant theory involves insufficient monoamine signalling and excess stress hormones leading to hippocampal inhibition and HPA axis hyperactivity. complimentary lines of research involve hypofrontality, hyperactive amygdalae and reward system dysfunction.

[jockmclaren47]

@iPlantChannel You are standing too close to the subject. The theory is Biological Reductionism. Low monoamine signalling etc. is an instance of the larger theory. A theory is a general explanatory model of a field of knowledge, not a microscopic application to each and every example within that field. You do not have a nuclear theory for each and every example of a power station, nor a theory of appendicectomy and a theory of bone grafting etc. They are examples of the larger theory.

[iPlantChannel]

@jockmclaren47 The reason there isn't a unique theory for every power station is that they are so much alike. Instead we have unique theories for different TYPES of power station - one for coal power stations, another for nuclear power stations and so on. Modern medical neuroscience finds that mental disorders are like power station types - that three people suffering from ADHD for example have so much in common at the level of the brain that it makes sense to develop a theory of ADHD. (contd.)

[jockmclaren47]

@iPlantChannel The general theory behind ALL powerstations is thermodynamic theory. Each power station is an instantiation of that theory, even though it may use other theories as well (e.g. nuclear). So what is the general theory behind biopsychiatry? It doesn't exist. It is presumed to be biological reductionism but, as I have shown in detail, that fails. You need to understand the nature and role of theories before making these wild claims. Philosophically, you are wrong.

[iPlantChannel]

@jockmclaren47 the "theory behind biopsychiatry" is neuroscience. our opinions on the philosophical foundations of neurscience as it relates to mental disorder clearly differ. my point is that even though neuroscience is still in its infancy it is already powerful enough to enable procedures like DBS for depression and rewarding brain stimulation. that fascinates me and I'm hoping and trying to promote discussion about how we want this increasingly powerful neuroscience to develop. interested?

[jockmclaren47]

@iPlantChannel The theory behind psychiatry is most emphatically NOT neuroscience. Mental concepts cannot be reduced to biological facts. If you believe they can, then please state for everybody to see just which theory you are using. Show how a mental concept such as "nonsense" can be rendered in biological terms, and don't try pulling promissory materialism on us (or Kandel's naive stuff). We are not impressed. You do not have a rational basis to your opinions, admit it.

[iPlantChannel]

@jockmclaren47 I never claimed to have a neuroscintific account of abstract concepts like "nonsense" - on the contrary I just said in my last reply that neuroscience is still in its infancy. We do however have a neuroscientific understanding of less abstract mental phenomena like vision, attention, decision-making, learning, attachment, etc. We also have a neuroscientific understanding of mental disorders. In the case of depression it involves monoamines, the HPA axis, hypofrontality and so on.

[jockmclaren47]

@iPlantChannel We have initial neurophysiologic understanding of the mechanisms of vision, decision-making, which are the basis of the biocognitive model, but the proper approach to mentalist concepts is on a mentalist level. There will never be a complete reductionist account of human behaviour so don't waste time now looking for it. Remember what happened to behaviorism. Mentalism is also problematic (cf. Freud) but reductionism is not the way to go.

[iPlantChannel]

@jockmclaren47 Good, we have our predictions then. If you're right, cognitive neuroscience won't amount to much and DBS will soon, as you say on your site, 'run into difficulties' as 'the improvements will not be maintained', and the whole enterprise will end much like leucotomy did. If I'm right, cognitive neuroscience will become increasingly informative and useful, and DBS (not to mention optogenetics) will become a more and more effective treatment of mental disorders.

[iPlantChannel]

@jockmclaren47 (contd.) You, on the other hand, want to place the emphasis on the unique character of each person's experiences and problems. I actually strongly support psychotherapy and am sceptical of psychopharmacological over-prescription. But I also see that the biological approach is getting increasingly powerful and interesting. If you don't want to discuss the details of neuroscience and disorder as they relate to DBS in this video then I don't think our discussion can go much further.

[caketheory]

This sounds like another bogus psychiatric treatment which falls into the same category as insulin coma therapy, metrazol convulsive therapy, lobotomy and ECT.

Lets take lobotomy for example which at the time it was considered to be helpful to the patient. Before the lobotomy patients were highly agitated suffering from crippling mental illness however after the lobotomy they were quiet uncomplaining and showed little concern for their troubles. Conclusion it works but in reality it was ABUSE

[iPlantChannel]

@caketheory what specifically about the iPlant is it you object to. we discuss the ethics and safety of iPlants on the iplant.eu website... check it out

[caketheory]

@iPlantChannel Hi, I object for its use in mental illness eg OCD and depression. I don't think these are real biological diseases because there is no medical test to prove you have them, therefore it would be insane to treat them in this manner.

I recommend looking at the ideas of the antipsychiatry movement. If you type "psychiatry" on Youtube and watch the first few vids they explain some of it. Also I did some videos and names to google would be Dr Joanna Moncrieff, Dr Thomas Szasz etc.

[iPlantChannel]

@caketheory Ok that's a different debate from the one I'm trying to engage in. Deep brain stimulation is only used as a last resort in very severe cases of mental illness, where there are clear neurological abnormalities, (e.g. hypofrontality and HPA/amygdala hyperactivity in the case of affective disorders), and much effort is put into protecting the expressed wishes of the patient and his/her relatives. Use of iPlants should involve strict adherence to similar patient protection policies.

[caketheory]

@iPlantChannel You shouldn't be saying that "hypofrontality and HPA/amygdala hyperactivity in the case of affective disorders"....................­. this is misleading people into making them think its a real disease.

This is just a hypothesis and is not an established pathology. If someone dies of Parkinsons for example they can confirm the diagnosis by finding a loss of neurons in the substantia nigra etc. 

The same can not be done for depression & OCD.

[iPlantChannel]

@caketheory affective disorders are very real as far as I'm concerned, and have been associated with abnormal activity in specific brain regions in hundreds of studies all over the world. these are FUNCTIONAL measurements though, so you can't expect to find them post mortem.

[caketheory]

@iPlantChannel They may be real to you but thats not good enough, they have to be an established medical disease if your going to advocate using such a dangerous treatment. Any kind of brain operation is very dangerous.

I did a google of "hypofrontality and affective disorders" and it didn't take long to find articles saying "Hypofrontality is not a well-replicated finding in affective disorders". Therefore I don't think your giving people all the facts.

[iPlantChannel]

@caketheory affective disorders ARE established medical conditions (I was asked to teach the neurobiology of anxiety and depression to medical students just a few months ago), that's why advanced treatments like deep brain stimulation are being made available. I don't know what kind of google search you did but hypofrontality has been associated with affective disorders in a large number of studies, HPA/amygdala hyperactivity even more so. I'm mainly interested in reward dysfunction though.

[caketheory]

@iPlantChannel You used the words "has been associated with" which also means of course that there are trials which "have not been associated with hypofrontality". 

So your saying that if people are unhappy working on the minimum wage and need motivation, deep brain stimulation could be of benefit?

[iPlantChannel]

@caketheory not every patient has to present with an abnormal measurement for it to be taken seriously, only a statistically significant number. for example, only a fraction of patients with Parkinson's disease have mutated DJ-1 proteins, yet there is a huge research effort to understand DJ-1, as it adds a statistically significant piece of information to the puzzle.

simply being unhappy at your job doesn't warrant brain surgery today; the procedure would have to be much much safer and cheaper.

[caketheory]

@iPlantChannel So if somebody was depressed in their job and they showed "abnormal measurement in specific brain areas" would they be candidates for this procedure?

[iPlantChannel]

@caketheory probably not, the patient would first have had to be diagnosed with a psychiatric disorder effectively treated with DBS. the patient would also have to be a non-responder to at least four other treatment options, including talk therapy and drugs. these requirements may change as DBS becomes safer and privatised (consider dental, optic or plastic surgery) but currently DBS is very much a last resort treatment, and is still in clinical trials in cases like depression.

[lyntonio]

I wonder if dbs would help with video production and editing

[MadMadamJess]

Great video, man! I'm getting DBS for my Cervical Dystonia..very interesting..

xoxoxo

[nofxmike06]

don't get the implant! its a tracking device!!!

[dossmanos8]

How does one get this implant? I suffer from long-term treatment-resistant depression. Is it only thru clinical trials?

[iPlantChannel]

@dossmanos8 clinical trails haven't started. the point of the video and the website is to encourage society to run such trials.

[nj754]

I don't see much downside. I want a deep brain stimulator.

[fearnoevilexceptbush]

Yes, al sorts of positive opportunities here. But as a consequence also horrific scenarios for abuse.

[iPlantChannel]

yes, that's why we want to discuss the technology before it arrives rather than after. check out the ethics section on the iPlant website.

[rhendawg]

bipolar type 1 is disqualified. and those with bipolar type II with psychotic features are disqualified. bipolar type II alone IS qualified.

[newmoongathering]

Thankyou. AT LEAST SOMBODY HAS THE RIGHT IDEA! I find it strange that it is also used to treat dystonia a movement disorder found very common in "Schizophrenics," a nonexistant psyche-disease used as an umbrella term for neuroligcal disease created mostly by industrialization. Deep Brain Stimulation is coming, its going ot be worse than the lobatomy.

[Daisydogsmummy]

No sound at all!! ???

[iPlantChannel]

there's sound, but you may have to turn it up