Posted by Bob on July 20, 2014, at 12:34:35
In reply to Re: Intranasal ketamine - Anyone? » Bob, posted by SLS on July 18, 2014, at 13:01:05
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> I'm sorry that DBS did not produce the results your were hoping for. I would be pretty angry. What site in the brain were the electrodes implanted - Brodman 25 or nucleus accumbens? How do they decide between the two? Can the outcome of DBS be predicted based upon symptom profile? Who makes the best and worst candidates for treatment?
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> Thanks, Bob.
>I had mine done at the Columbia University & NY Presbyterian Medical Center in Manhattan. That site was part of a study named "BROADEN" that was started with Helen Mayberg and Emory University Medical Center here in the US (originally it began in Canada). This particular study employed the Brodmann Area 25 Anterior Cingulate Gyrus, whereas another study associated with the Cleveland Clinic was using the nucleus accumbens.
It's not that it did nothing... it did all kinds of things eventually - both good and bad. When I think about it, that's exactly what almost every treatment I've tried has done that wasn't totally ineffective. I was definitely more disappointed and angry than just a failed med trial but the possiblility of failure is very real and that must be kept in mind. I knew the odds weren't great. Like I have said before, I still feel that a very low level of stimulation might help me. It's still implanted in me and I have plans to go back up there to inquire.
As far as questions about methodology and effectiveness go, I'm not qualified to answer that and I don't think anyone really is. Like the medicines and possibly even more so I don't think the mechanisms of action are understood. The area of the brain they chose was study based and all the areas are best guesses based on previous brain research from such things as old psychosurgery procedures and theories as well as all the brain imaging and science from more recently. There are other areas under consideration in other studies: the aforementioned nucleus accumbens, the lateral habenula, the Medial Forebrain Bundle (MDF) and possibly some others. The studies try to pick people with the simplest, purest if you will, forms of MDD not complicated by bipolar, BPD, schizophreneic, or other syndromal aspects. I'd be surprised if they could predict whether a certain patient who met the criteria might respond better than another.
You managing to get DBS treatment for your illness is at this point entirely dependent on your ability to get recruited in a study. This is all affected by what active studies are available and currently enrolling, and then the logistics of you being able to participate based on time comittment and proximity to your location. None of these procedures are FDA approved and it's anyone's guess when they might be. Obviously if they become approved it will change the situation significantly. I "lucked out" getting accepted in NY since all the patients in both studies in the US amounted to only a handful. A good place to start would be clinicaltrials.gov or a similar resource. Search for DBS and depression.
- Bob
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URL: http://www.dr-bob.org/babble/20140717/msgs/1068592.html