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"Powerful magnetic pulses applied to the scalp to stimulate the brain can bring fast relief to many severely depressed patients for whom standard treatments have failed. Yet it's been a mystery exactly how transcranial magnetic stimulation, as the treatment is known, changes the brain to dissipate depression. Now, research led by Stanford Medicine scientists has found that the treatment works by reversing the direction of abnormal brain signals."
"When they analyzed fMRI data across the whole brain, one connection stood out. In the normal brain, the anterior insula, a region that integrates bodily sensations, sends signals to a region that governs emotions, the anterior cingulate cortex.
"You could think of it as the anterior cingulate cortex receiving this information about the body—like heart rate or temperature—and then deciding how to feel on the basis of all these signals," Mitra said.
In three-quarters of the participants with depression, however, the typical flow of activity was reversed: The anterior cingulate cortex sent signals to the anterior insula. The more severe the depression, the higher the proportion of signals that traveled the wrong way."
"When depressed patients were treated with SNT, the flow of neural activity shifted to the normal direction within a week, coinciding with a lifting of their depression."
https://medicalxpress.com/news/2023-05-depression-reversing-brain-wrong.html
(Score: 2) by HiThere on Thursday May 18, @02:09PM (12 children)
*If this works, then I expect that normally the neural traffic flows in both directions, and that in the depressed folks *most of the signals flow from A ( the "anterior cingulate cortex") to B (the "anterior insula"). The question is does it suppress the flow or does it stimulate the flow from B to A? That's a significant difference in the method of action. Hopefully is stimulates the flow from B to A, as that would be sort of like saying to yourself "Well, my body's feeling alright, so things aren't too bad.".
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 4, Insightful) by JoeMerchant on Thursday May 18, @02:42PM (10 children)
TMS is a rather large, rather imprecise hammer, and when people have something wrong in their heads, hitting them with the big hammer has a chance to make things better. That's what they're studying.
Of course, orally administered systemically active psychotropic drugs are even less precise, and often harder hitting, and they come with much stronger potential for side effects / dose efficacy variation due to the patient's systemic state (drunk any grapefruit juice lately? and 1000s of other variables.) But, they've been around longer and been studied more, so they aren't a bad baseline to compare with.
The thing about the severely depressed population is that they are at serious risk of death from the condition, so "try anything" kinda falls under humanitarian exemptions.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 0) by Anonymous Coward on Thursday May 18, @02:47PM (4 children)
https://www.ucsf.edu/news/2022/09/423891/lsd-molecules-counter-depression-without-trip [ucsf.edu]
(Score: 2) by ElizabethGreene on Thursday May 18, @03:17PM (3 children)
Yes anon, that's another example of Parent's "try anything" exemption.
(Score: 4, Interesting) by aafcac on Thursday May 18, @06:00PM (2 children)
There's also a lot of times where something appears to work, but the consequences of it can take decades to become apparent. This includes things like Tardive dyskinesia from antipsychotic medication or just completely fucking an autistic person's entire brain up using Applied Behavioral Analysis. It looks effective in the short term for the same reason that it works on animals, in the long term, it doesn't do anything to help and just pushes the patient into a position where massive amounts of their emotions are being suppressed until they can't contain it.
It's a shame that longitudinal studies can be so hard to conduct without running afoul of ethics violations. As it's been the only way to know the real long term consequences in many cases. Thankfully, things like heart cells on a chip can help to identify when things are outright toxic to an organ, hopefully eventually it can be figured out for more complicated systems.
(Score: 3, Interesting) by JoeMerchant on Thursday May 18, @07:33PM (1 child)
>just completely fucking an autistic person's entire brain up using Applied Behavioral Analysis.
No mystery there - PTSD from sadistic torture is well documented.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 3, Interesting) by aafcac on Friday May 19, @12:32AM
Right, the problem though is predicting such things ahead of time and then determining whether the results are better enough than doing nothing to justify the treatment. And that's assuming that the people involved know enough to properly communicate the risks and benefits of the treatment in a way that the patient can understand. Unfortunately, in many cases you're talking about children where the parents are making the decisions. Not to mention that in some cases, even if a treatment is safe, it may not be effective if what's causing the problem is something else.
(Score: 2) by aafcac on Thursday May 18, @05:56PM (4 children)
The medications have been getting more precise over time with better understanding of how the brain works and better methods of assessing what is going on. More modern medication doesn't have as many interactions because of that whereas MAOIs tend to interact with just about everything.
The problem though is that medication and interventions like this, don't hit the core problem. They can be very helpful in getting patients into a position where they're able to properly engage in therapy, but they don't address the underlying concerns that lead to these problems in the first place. AFAIK, it's still just a theory that neurotransmitter levels are a cause of the problems and fixing them will fix anything rather than being a temporary byproduct of something else going on.
I do think that things will get progressively better targeted over time and that depending upon how narrow the scope of the neurons needed to be targeted are, that better targeting will be possible. But, I doubt that it ever will be that targeted just because these things are different from cancer cells in that they tend to involve larger networks in the brain.
(Score: 4, Interesting) by JoeMerchant on Thursday May 18, @07:44PM (3 children)
>they don't address the underlying concerns that lead to these problems in the first place.
Dark joke from the depression treatment device sales staff:
"Sure ECT works, for a while, because you forget that your life sucks. Once that reality comes back into focus, the depression returns."
ECT - Electro Convulsive Therapy. Originally administered as 125VAC @60Hz directly to the temples, patients would be given a wooden stick to bite down on... Side effects included broken bones (like femurs) from the patients own muscles seizing so strongly, and amnesia. Over the years they refined the therapy (basically with current limiting) until you get the amnesia without all the other nasty seizure stuff. It only works to treat depression when administered at levels that cause amnesia, so...
The rat model to test severity of depression is the forced swim test. Rats are first trained/conditioned to swim in a deep tank of water with an (invisible to the rat) underwater platform placed randomly somewhere in the tank. They learn to search until they find the platform, then they can stand high enough to breathe without swimming. So, researchers being the sadistic bastards they are, the measure of depression is to take rats so trained and then put them in an identical tank, lacking the platform. The longer the rat swims searching for the platform before giving up to drown, the less depressed the rat is.
Treading water with no hope for rest, pretty much sums up what depresses a lot of people.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 3, Interesting) by aafcac on Friday May 19, @12:35AM (1 child)
Yes, ECT got somewhat safer later on when they started to administer medication to reduce the severity of the muscle spasms. From what I understand the magnetic version, BCT, is supposed to be less problematic in terms of the memory problems, but it's not something that I've kept current on as it's not something that I need and I don't know anybody else that has needed it either.
But, yes, memory problems with ECT are well known and have been for many decades. That was a large part of why Hemingway chose to murder himself, as his memory was gone following the treatments. I don't know how long he waited before concluding that things wouldn't get better. It's also unclear to me whether it was the memory problems or if it didn't give enough relief from the depressive symptoms to get him clear of the suicidal ideation.
(Score: 3, Insightful) by JoeMerchant on Friday May 19, @12:58AM
The documentaries I have seen about Hemingway painted him as an overcompensating highly insecure individual, highly entertaining but not the kind of (total) life experience most people would choose.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 2) by pdfernhout on Friday May 19, @03:05PM
More on ECT: https://www.madinamerica.com/2022/02/fear-loathing-ect-debate/ [madinamerica.com]
"To the surprise of many people, electroconvulsive therapy (ECT) is still being administered to approximately a million people a year internationally, predominantly women and old people. It involves passing enough electric current through the human brain, eight to twelve times, to cause convulsions, in the hope of somehow alleviating emotional suffering, primarily depression.
Our recent review reported that there have only ever been 11 placebo-controlled studies (where general anaesthesia is administered but the electric shock is withheld). All 11 were pre-1986, had very small sample sizes, and were seriously flawed. Four found ECT produced better outcomes for some patients in the short-term, five found no difference between the two groups at the end of treatment, and two produced mixed results, including one where psychiatrists’ ratings produced a difference, but the ratings of nurses and patients did not.
No studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have concluded that ECT is more effective than placebo, despite the studies’ multiple failings. Meanwhile evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated.
... I am not the first to wonder how such highly educated and well-intentioned people can defend an obviously dangerous procedure in the absence of any robust evidence of efficacy or safety, and, moreover, why some of them do it so vehemently.
A partial explanation, perhaps, comes from Professor Leon Festinger: He developed his theory of cognitive dissonance after closely observing a cult whose leader had received messages from another planet that a flood would destroy the earth on December 21, 1954. Many members quit jobs and discarded possessions in preparation. When doomsday came and went, some cult members acknowledged they had got it wrong, but the most committed adhered to their beliefs even more strongly (Festinger et al., 1956). ... Or, in the words of Professor Paul Simon (1965), ‘A man hears what he wants to hear and disregards the rest.’"
In general, most of drug-based psychiatry also suffers from the same lack of evidence, like Marcia Angell says here:
http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/ [nybooks.com]
"The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."
Or Peter Goetzsche says here:
https://www.amazon.com/Deadly-Psychiatry-Organised-Denial-Gotzsche-ebook/dp/B014SO7GHS [amazon.com]
"DEADLY PSYCHIATRY AND ORGANISED DENIAL explains in evidence-based detail why the way we currently use psychiatric drugs does far more harm than good. Professor, Doctor of Medical Science, Peter C. Gøtzsche documents that psychiatric drugs kill more than half a million people every year among those aged 65 and above in the United States and Europe. This makes psychiatric drugs the third leading cause of death, after heart disease and cancer. Gøtzsche explains that we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients' mental and physical health and survival. It can be difficult, however, to come off the drugs, as many people become dependent on them. As the withdrawal symptoms can be severe, long-lasting and even dangerous, slow tapering is usually necessary. In his book, Gøtzsche debunks the many myths that leading psychiatrists - very often on drug industry payroll - have created and nurtured over decades in order to conceal the fact that biological psychiatry has generally been a failure. Biological psychiatry sees drugs as the "solution" for virtually all problems, in marked contrast to the patients' views. Most patients don't respond to the drugs they receive but, unfortunately, the psychiatrists' frustrations over the lack of progress often lead to more diagnoses, more drugs and higher doses, harming the patients further."
One alternative: https://tlc.ku.edu/ [ku.edu]
"We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life. (Stephen Ilardi, PhD)"
"Across the industrialized modern world, clinical depression has reached epidemic proportions, despite a staggering increase in the use of antidepressant medication. In fact, depression is now the single leading cause of work-related disability for adults under 50. However, there is strong evidence that depression can be both prevented and treated through a set of straightforward changes in lifestyle. Our research has demonstrated that TLC is an effective treatment for depression, with over 70% of patients experiencing a favorable response, as measured by symptom reduction of at least 50%."
TLC focuses on exercise, sunlight & vitamin D, good nutrition with adequate omega-3s, sufficient good sleep, positive socialization, and avoiding negative ruminant thinking. In general, the worst side effects of TLC are things like moving to a healthy weight and having better overall health.
Other health readings I've collected over the years (including about recovery from trauma, which is a somewhat different issue than just depression): https://github.com/pdfernhout/High-Performance-Organizations-Reading-List#health-and-wellness [github.com]
The biggest challenge of the 21st century: the irony of technologies of abundance used by scarcity-minded people.
(Score: 2) by driverless on Friday May 19, @06:55AM
Hey, they're going to reverse the polarity of the neural flow, it worked for the Doctor so why shouldn't it work here?