Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
I think this may the next big thing if for no other reason than it gives doctors a new high-level revenue stream. It certainly would be lovely if such a procedure worked without serious side effects. It strikes me as more experimental and crude in nature at the present than what might be possible in the future. I hope the Hippocratic oath of "do no harm" ends up being the case with this but it seems unlikely at present.I found a study of deep brain stimulation used for Parkinson's disease:http://www.medpagetoday.com/Geriatrics/Parkinsonsdisease/12340I'd like to point out from this article:"Key efficacy findings at six months, given as changes from baseline, included:" " * UPDRS Activities of Daily Living scores: 0 medical therapy, -4.6 deep brain stimulation (P<0.001) * Quality of life, single index: 0.4 medical therapy, -7.7 deep brain stimulation (P<0.001) * Wechsler working memory index: 1.0 medical therapy, -1.6 deep brain stimulation (P=0.005) * Wechsler processing speed index: 0.7 medical therapy, -2.1 deep brain stimulation (P=0.006) The latter two findings reflect decreases in neurocognitive function with deep brain stimulation, suggesting an adverse effect for the procedure, although it was not counted as such in the JAMA report.In 10 other tests of cognitive ability, significant decreases among those in the deep brain stimulation group were seen in two -- phonemic fluency and delayed recall in the Brief Visuospatial Memory Test -- and trends were noted in several others.On the other hand, neither group showed significant changes in depression or dementia scores on standard instruments.Totals of 659 adverse effects were reported in the deep brain stimulation group and 236 in the medical-therapy group.These included falls, gait disturbance, dyskinesia, motor dysfunction, balance disorder, depression, and dystonia.Falls, gait disturbance, depression and dystonia were significantly more common with deep brain stimulation. Effects related to implantation of the neurostimulation device, such as surgical site infections and pain, were seen in about 10% of the deep brain stimulation patients.In addition to 16 cases of surgical site infections, serious adverse events in the deep brain stimulation group included nervous system disorders in 15 patients, psychiatric disorders in 11, and device-related complications in eight. Falls resulting in injury occurred in six patients."
It's interesting. For me, as long as it takes sometimes on a trial of an antidepressant sometimes, with as many of them as there are, I would think it would take longer than 5 years, not necessarily to try every anti-depressant, but to try the variety of other therapies, I feel to give them a good shot, I'd give it more like 8-10 years without results before I'd consider this, although we're on year 6 now, and still aren't working on the depression what with working on the mania and the side effects from the medication for that. So with what I just said, would I consider DBS in two years? No, because I don't think we could have tried everything yet by then, and my psychotherapy is starting to change; rather, I'm starting to have a paradigm shift that may finally result in some lasting change, slow as these changes may be to come. So we'll see, frustrating though years of trial and error of drugs may be, with a few years of Effexor working mixed somewhere in the middle.I'd have to feel like alot of options had been exhausted before considering this, although it has crossed my mind from time to time since I've heard of it before. I think in 4 years if not much progress has been made, with my new paradign and with a variety of medications tried, I'd be thinking alot more, not that I"d likely have access to it or some of the other therapies they mentioned.
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