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Sad switch implant eases depression

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  • BILLSfan
    Mar. 1, 2005. 01:00
    Message 1 of 1 , Mar 1, 2005
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      Mar. 1, 2005.
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      Sad switch implant eases depression
      Toronto team uses brain pacemaker

      `Amazing' device aids resistant cases
      ELAINE CAREY
      MEDICAL REPORTER

      Toronto scientists have implanted a brain pacemaker that turns down a
      key "sad" part of the brain in seriously depressed patients.In
      breakthrough research published yesterday in the prestigious journal
      /Neuron,/ the scientists from Toronto Western Hospital and the Baycrest
      Centre report how the mechanism -- which continually stimulates a part
      of the brain that regulates mood -- turned around the lives of four
      patients. All of them were so severely depressed they hadn't been able
      to work for years and could barely get out of bed. They had not
      responded to treatment with drugs, cognitive therapy or even shock
      treatment. But after a year with the pacemaker, they have all returned
      to normal lives and are even starting new jobs. Two others, older men
      with later-onset depression, did not improve. One of the patients,
      Jeanne Harris, 50, had battled the illness for nearly a decade. Despite
      a cocktail of drugs, she was unable to work or maintain contact with
      friends. In one six-month stretch, she travelled from bed to couch and
      back, bathing and changing clothes only on the one day a week she was
      taken to see her doctor.Nearly two years ago Harris became the first to
      undergo the surgery. A few hours later, she was home clipping hedges.
      "It was absolutely unbelievable -- to do it and to be feeling normal and
      enjoying it like I remember I used to feel," she recalled in an
      interview yesterday.As many as 120 million people around the world
      suffer from depression and 10 to 20 per cent do not respond to
      treatment. The research team, led by neurologist Dr. Helen Mayberg of
      Baycrest and surgeon Dr. Andres Lozano at Toronto Western, discovered
      through imaging techniques that in severe depression, a region of the
      brain called the subgenual cingulate, or Cg25, is overstimulated. That
      region is "the sadness centre" that controls mood, sleep, appetite and
      behaviour, Lozano said.The scientists adapted a treatment used to
      neutralize brain impulses that cause severe tremors and fatigue in cases
      of severe Parkinson's disease. Lozano drilled two small holes in the
      patients' skulls and implanted thin electrodes deep within the Cg25
      area. The wires were threaded down under the scalp and hooked to the
      pacemaker -- like a remote control -- under the skin at the base of
      their necks. The electrode impulses were then adjusted to slow down the
      brain stimulation to the right speed. Lozano likens it to a thermostat
      turned to 40C, "which is not a comfortable setting. We were able to turn
      it down to 20C where they felt normal." "It's absolutely amazing," said
      Debbie, 47, a Barrie patient who had been in a severe depression for
      eight years. Debbie, who asked that her real name not be used, is now
      working non-stop on a new business venture and "I'm absolutely
      thrilled." Before the treatment, "I could hardly get up, I stared out
      the window hour after hour until night fell when I could watch some
      television," she said. "It had such an insidious feel to it, I wanted
      out of life. I couldn't imagine living any more."It took almost a year
      to get the current exactly right, but once it was, "I knew it right
      away. I didn't feel drugged anymore. Now I'm able to communicate, I get
      out and I'm just normal." The researchers plan to repeat the study with
      four more patients in Toronto and "we'd like other countries in the
      world to take this up to see if they too can see results," Lozano
      said.While the group was so small that conclusions are hard to draw,
      "this (severe, treatment-resistant depression) is a different illness
      than we regularly see," said psychiatrist Dr. Mark Berger, a professor
      of psychiatry who specializes in depression at the University of
      Toronto. Both Mayberg and Lozano are internationally renowned in their
      fields and "this is cutting-edge academic research," Berger said.
      "Toronto is highly regarded in this important work."Mayberg, who is now
      at Emory University School of Medicine in Atlanta, has devoted her
      academic life to studying depression and "this is a pretty astounding
      outcome that certainly begs to have more done to see what we've got,"
      she said. To avoid a placebo effect, the patients were not told when the
      electrical current was turned on or off, she said. The treatment would
      never be used in patients who respond to drug or cognitive therapy and
      probably even shock therapy, she said, because "if you're amenable to
      another treatment, why would you want to have brain surgery?" Debbie has
      a gift for Mayberg when she sees her next, a butterfly pin. "That's what
      I feel. She's taken me out of this cocoon I could not get out of myself
      no matter how hard I struggled." with files from Canadian Press



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