[HN Gopher] The first study of individualized brain stimulation ...
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The first study of individualized brain stimulation to treat severe
depression
Author : ed
Score : 76 points
Date : 2021-10-15 14:46 UTC (1 days ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| concinds wrote:
| I'm glad this is helping some people, and I'm always in favor of
| treatments that help people who are "lost causes" (people with
| chronic illness and every treatment they tried so far has
| failed), but this stuff really creeps me out. There's that story
| of the Navy SEAL that developed mania and psychosis from
| excessive use of rTMS that was making the rounds a few years ago
| (https://rewired.inewsource.org/ucsd-kevin-murphy-prtms-
| navy-...). It just seems like an example of scientists playing
| around with a complex system they have a very incomplete
| understanding of, with potentially risky outcomes. The brain
| isn't a heart, it's not just a matter of getting it "beating" at
| the right pace. With the Navy SEAL who went insane, the main
| problem seems to have been excessive treatment (rTMS worked at
| first, but the effects kept going away without more stimulation,
| so even though he was supposed to be "cured" after a few months
| and require no further treatment, he had essentially become
| "addicted" to brain stimulation). Brain stimulation implants seem
| too similar: meant to stimulate certain emotions in perpetuity,
| with nothing really addressing the underlying causes.
| Psychotropics are already suboptimal in that same sense
| (addressing symptoms, not root causes) but it seems like a safe
| bet that this will have more unintended effects than drugs. I
| don't want to discourage anyone here from getting treatment (as a
| sidenote, what worked for me for depression was internal family
| systems therapy, which is also pretty "out there" and cutting
| edge) but I'm wary that with more focus and funding for rTMS,
| there'll be less attention on finding more "root cause"
| solutions.
| davesque wrote:
| I highly agree with this sentiment. After all, it seems in a
| way that emotions are a reaction to the environment and to
| one's circumstance. If those are poor, shouldn't the emotions
| also be poor in a healthy person? Otherwise, what incentive
| would a person have to seek out a better situation? In my own
| struggles with depression, I feel one truth I've discovered is
| that my emotions are calling attention to things in my life,
| both good and bad. That's useful. I wouldn't want to always
| feel good about everything.
|
| That's why I hope treatments like these are looked at as
| providing some kind of temporary relief that could help a
| person find motivation to change things that are bothering
| them. I know the kind of negativity a person can experience
| during depression can be totally debilitating. It should treat
| that debilitation.
| hprotagonist wrote:
| This is DBS, similar to therapies for motor disorders like
| Parkinson's. It's also invasive; a surgery is performed to
| implant an electrode into the striatum. rTMS is noninvasive and
| much less targeted.
|
| Based partly on motor disease research into disorders like
| Parkinson's disease, there is a growing theory in the
| neurosciences that brain disrhythmic behavior _is_ the root
| cause for a variety of disorders, with a plastic feedback loop
| on top that reinforces things as the disease progresses.
| Closed-loop stimulation that disturbs the maladaptive behavior
| when it starts works stunningly well for some motor diseases,
| and at least in one patient, for MDD as well.
| concinds wrote:
| Interesting, that makes me trust this quite a bit more.
| Regardless, this is bound to really contribute to our
| understanding of the brain, so I'm grateful for this
| research.
| maybelsyrup wrote:
| Great comment.
|
| > but the effects kept going away without more stimulation, so
| even though he was supposed to be "cured" after a few months
| and require no further treatment
|
| This describes most mental health treatments, especially the
| drugs.
|
| > internal family systems therapy
|
| I'm a huge fan of this, too. Did wonders for my relationships.
|
| > that story of the Navy SEAL
|
| This is fascinating. Given what you read about these guys these
| days, needing serious professional help doesn't exactly
| surprise me.
| throwaway81523 wrote:
| https://en.wikipedia.org/wiki/Wirehead_(science_fiction)
| fpgaminer wrote:
| > It just seems like an example of scientists playing around
| with a complex system they have a very incomplete understanding
| of, with potentially risky outcomes.
|
| Scientists don't "play" around with medicine; this kind of
| stuff is highly regulated.
|
| TMS is only used to treat depression when all other treatments
| have failed. At that point, the benefits outweigh the risks.
| Namely, at that point the patient is at risk of _death_ and no
| other options are available.
|
| > Psychotropics are already suboptimal in that same sense
| (addressing symptoms, not root causes)
|
| We don't know the root causes of the vast majority of diseases.
| So we can't say whether psychotropics treat the root causes or
| not. But we do know they work. They save and improve many, many
| lives.
|
| And that's how modern medicine works. Does it work? Is it safe?
| Then we use it. All modern day treatments are suboptimal. That
| doesn't mean they don't work, and that doesn't mean people
| shouldn't use them when needed.
|
| It's interesting that I don't see these kind of skeptical
| comments about antihistamines. Modern antihistamines are
| suboptimal (I should know), but everyone with allergies is glad
| they exist.
|
| > I don't want to discourage anyone here from getting treatment
|
| Personally I think this comment will contribute to treatment
| hesitation, whether that was intended or not. Mental health is
| already highly stigmatized, and seeking help for it is a
| daunting task. Telling people that scientists are "playing"
| around with their brain isn't helpful. Good doctors are
| following a strict, science backed playbook for the treatment
| of mental disorders. These playbooks save lives.
| herval wrote:
| While TMS _should_ be a last resort thing, what's actually
| seems to be happening (anecdotally at least) is it gets
| prescribed like candy - just like opioids and
| antidepressants.
|
| I had a pretty rough time during the pandemic and reached out
| to a couple clinics for maybe trying psychotherapy, and after
| a single 30 minutes consultation, both concluded I should try
| TMS first, because "it just works". One of them literally
| added me to a marketing mailing and kept spamming me about
| it.
|
| So yea, maybe it's highly regulated outside the US?
| concinds wrote:
| > Personally I think this comment will contribute to
| treatment hesitation
|
| You're right; I want to make sure to say that people should
| never, ever just decide to "live with" whatever ails them.
| There's solutions, and 99% of the time the price is worth
| paying. Exhaust your options but never "settle" for "this is
| just how my life will always be", whatever works, works. I
| have psychiatrists in my family so I know for a _fact_ that
| psychotropics can turn someone 's whole life around, durably,
| and do a 360deg on their quality of life; and sometimes have
| their lives literally saved. I don't want anyone reading this
| to think I'm on the "antipsychiatry" side of things.
|
| I was approaching this from a "medical technology" PoV,
| hoping that there would be more effective, permanent
| treatments by now, but I hope if there are any patients or
| future patients reading this, that they don't write this off
| if nothing else worked. Don't necessarily trust every doctor
| (if they give you treatments that don't work or don't listen
| properly to your symptoms) but do listen to _your_ doctor
| once you find a good one, which there are a lot of.
|
| I was using the "playing around" language out of the
| frustration that everyone who does have chronic illness that
| doctors have been unable to address (even with experimental
| treatments), knows. But it's very important people don't
| throw out the baby with the bathwater, and even more
| important to do whatever it takes to become unencumbered by
| whatever problem they have.
|
| I can't edit my comment above anymore, but I just want to
| say, if you have a chronic condition, you seriously can't
| imagine how much better your life will be once you get it
| under control. Trust the process, you can find solutions no
| matter how hopeless it feels.
| AndrewBissell wrote:
| From the same newspaper in 1970: "Brain Researcher Jose Delgado
| Asks -- 'What Kind of Humans Would We Like to Construct?' ":
| https://www.nytimes.com/1970/11/15/archives/brain-researcher...
| drawqrtz wrote:
| https://archive.vn/VDl10
| echopurity wrote:
| A one person experiment? Zero mention of social factors of
| depression? 250 million people with depression just need their
| brain shocked regularly? Sounds right for HN.
| hprotagonist wrote:
| more technical presser:
| https://www.fiercebiotech.com/medtech/ucsf-health-s-customiz...
|
| The paper: https://www.nature.com/articles/s41591-021-01480-w
| stooliepidgin wrote:
| I'm having TMS done for 9 weeks starting at the end of this month
| for treatment-resistant, endogenous depression. Wish me luck.
|
| I'm considering doing a ketamine treatment too.
| fpgaminer wrote:
| Best of luck to you! I hope everything goes well.
| hypersoar wrote:
| Good luck! I went through a course of TMS last year and had
| pretty good results.
| smitty1e wrote:
| Getting a Louis Wu vibe here:
|
| https://www.wireheading.com/wirehead.html
| pgt wrote:
| If you simulate a depressed brain sufficiently accurately, are
| you prolonging the suffering of a depressed mind?
| drdeca wrote:
| Stimulation, not simulation.
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