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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by SLS on December 25, 2011, at 15:55:39
Deep Brain Stimulation (DBS)
Since I have all but run out of pharmacological options for treating bipolar depression, I am beginning to think about DBS.
Would anyone like to offer comments?
Thanks.
- Scott
Posted by jhj on December 25, 2011, at 23:58:36
In reply to DBS - Any comments?, posted by SLS on December 25, 2011, at 15:55:39
HiI read that Deep Brain Stimulation is probably the most promising treatment for TRD. However, i have not seen any controlled trials showing its effectiveness to rule out placebo effect. i am waiting eagerly for the results of the studies of DBS being conducted by Medtronic and St Jude Medical.
jhj
Posted by Phillipa on December 26, 2011, at 9:41:58
In reply to Re: DBS - Any comments? » SLS, posted by jhj on December 25, 2011, at 23:58:36
Have the results for parkinson's still positive? I wonder if parkinson's is somehow related to depression? Phillipa
Posted by Bob on December 26, 2011, at 20:23:27
In reply to DBS - Any comments?, posted by SLS on December 25, 2011, at 15:55:39
> Deep Brain Stimulation (DBS)
>
> Since I have all but run out of pharmacological options for treating bipolar depression, I am beginning to think about DBS.
>
> Would anyone like to offer comments?
>
> Thanks.
>
>
Is there any particular aspect of it that you're wondering about?Bob
> - Scott
Posted by SLS on December 26, 2011, at 23:09:57
In reply to Re: DBS - Any comments? » SLS, posted by Bob on December 26, 2011, at 20:23:27
> > Deep Brain Stimulation (DBS)
> >
> > Since I have all but run out of pharmacological options for treating bipolar depression, I am beginning to think about DBS.
> >
> > Would anyone like to offer comments?
> >
> > Thanks.
> Is there any particular aspect of it that you're wondering about?
It's hard to know where to start.How well does DBS work? I know you received only a partial improvement. Has this improvement remained stable over time?
What percentage of TRD patients attain remission with DBS treatment?
What are the dangers involved with DBS treatment?
Would you recommend DBS? Why or why not?
Do you plan on continuing DBS treatment?
Is there a particular case profile that is more or less apt to respond to DBS treatment? Bipolar? What are the symptoms of your depression?
Thanks.
I'm sure that more questions will follow.
- Scott
Posted by bleauberry on December 27, 2011, at 5:06:35
In reply to DBS - Any comments?, posted by SLS on December 25, 2011, at 15:55:39
I appreciate those in life who never give up no matter what. Meds, herbs, procedures, experimental, whatever.....doesn't matter.....the point is to keep fighting agaInst the evil. DBS is another tool in our war chest to do that.
Sure do wish this war was a bit easier though!
Posted by SLS on December 27, 2011, at 7:09:05
In reply to Re: DBS - Any comments?, posted by bleauberry on December 27, 2011, at 5:06:35
> I appreciate those in life who never give up no matter what.
It sometimes defies logic. It would be easier to just give up. However, logic would then take over and lead one down a very dark road.
- Scott
Posted by Bob on December 27, 2011, at 21:41:07
In reply to Re: DBS - Any comments? » Bob, posted by SLS on December 26, 2011, at 23:09:57
> > > Deep Brain Stimulation (DBS)
> > >
> > > Since I have all but run out of pharmacological options for treating bipolar depression, I am beginning to think about DBS.
> > >
> > > Would anyone like to offer comments?
> > >
> > > Thanks.
>
> > Is there any particular aspect of it that you're wondering about?
>
>
> It's hard to know where to start.Tell me about it!
>
> How well does DBS work? I know you received only a partial improvement. Has this improvement remained stable over time?As with any other treatment, I can't say how well it might work for another individual. It wasn't so great for me but it did effect change that meds were not doing any longer. The one thing it did was give more energy and I found myself doing things I never would have done before. Problem was, I rarely felt any better... I was just doing things.
It was not stable over time but IMO that was because they were ALWAYS modifying the stimulation parameters. I was "deactivated" over a year ago and slowly the effects (good and bad) faded away, just like with any other treatment I've had. I'm not sure people like you and I can expect any treatment to produce a permanent change after that treatment is removed of course.
>
> What percentage of TRD patients attain remission with DBS treatment?It's hard to say. They didn't share overall observational information or study results. I've seen preliminary studies claiming as high as 65%, and then down around 30% after one year from another report. I would tend to guess it's nearer the lower end of that window as time goes on. They say the response rate for ECT is as high as 85%, but at what cost (i.e. memory problems) and for how long?!
>
> What are the dangers involved with DBS treatment?This info is available on the internet as many of the dangers stemming from the actual surgery and procedure are similar to the operations for DBS used in Parkinsons, including a risk of stroke/bleeding (I thought it was something like 5%), or infection. There are other things like possible device and wire breakage etc., but I think those are rare. Then once the device is turned on they go slow enough that you would be able to self-monitor for adverse neurological/psychological effects which seems to be reversible with a shutoff of stimulation. I did get some memory and confusion problems and some tingling in my hands at times. If you ever got treated with this device they would be very thorough in making sure you were informed of all the risks and possible adverse effects.
>
> Would you recommend DBS? Why or why not?For someone like you who has tried almost everything imaginable and reasonable I think it might be worth your effort - You never know. One question I would have is how you might have responded to ECT, if at all. That could (and I emphasize the could) be an indicator of possible response here, although this device is slow with it's effects in my experience.
>
> Do you plan on continuing DBS treatment?I haven't been stimulated in over a year, but still have plans to go back and try the device at a very low level, which I would want to leave it at for a long time. If that didn't produce the effect I desire, then I think I would give up on it. The big problem I had with being in the confines of the study was that I had no say in how they set the stimulation parameters. That was annoying.
>
> Is there a particular case profile that is more or less apt to respond to DBS treatment? Bipolar? What are the symptoms of your depression?Unfortunately I am extremely sensitive to all treatments I have received and DBS was no exception. From what I've seen however, you seem to be the exact opposite where you are not very adversly affected with most meds (side effects that is). You are also unipolar as far as I know which is what they're looking for in terms of patient diagnosis. They want the most uncomplicated, pure depressive profile possible. I personally am easily agitated by many stimulating treatments. I have never been diagnosed as bipolar in any respect and have never to my knowledge experienced any kind of recognizable, classic mania. I do have very significant levels of pathological anxiety - especially in the more recent years - and this wasn't very well addressed with the DBS IMO.
I also have a ruminative component to my depression when it gets worse, and that wasn't helped by the treatment either. I think I remember you saying that you had some sort of similar component to your problem that you addressed with CBT? The other problem that kept cropping up for me eventually was increasing irritability. This has happened with many meds as well, so it may just be me. Who knows. Like we all are aware YMMV for any of this stuff regarding any particular individual. The biggest hurdle I currently see for anyone seeking this treatment is that it is difficult to get into the studies, which are the only way I know to access it for now.
I will be happy to answer any other questions you have Scott.
Bob
>
> Thanks.
>
> I'm sure that more questions will follow.
>
>
> - Scott
Posted by SLS on December 28, 2011, at 6:01:29
In reply to Re: DBS - Any comments?, posted by Bob on December 27, 2011, at 21:41:07
Hi Bob.
Thank you for your generous reply.
I have tried ECT and failed to respond to bilateral treatments.
I am what has been called Bipolar III. I have become severely manic/psychotic in association with drug treatment. I never had a spontaneous manic episode. I was an ultra rapid cycler, though. I had a consistent pattern of 8 days of depression followed by 3 days of euthymia. Once I learned that this was a biological rhythm, I was able to keep a social calendar around it. This occurred for a period of two years and ceased with my first exposure to lithium.
I might not be a candidate for a DBS study.
They should use PET scans to determine whether or not someone will profit from DBS. I'm guessing that a DFG PET scan would show hyperactivity in subgenual cingulate cortex.
- Scott
Posted by Phillipa on December 28, 2011, at 18:51:17
In reply to Re: DBS - Any comments? » Bob, posted by SLS on December 28, 2011, at 6:01:29
Scott didn't know that thought strictly bipolar so you have the med triggering bipolar? So technically doesn't this give you a diagnosis of MDD? Phillipa
Posted by SLS on December 28, 2011, at 19:56:56
In reply to Re: DBS - Any comments? » SLS, posted by Phillipa on December 28, 2011, at 18:51:17
> Scott didn't know that thought strictly bipolar so you have the med triggering bipolar? So technically doesn't this give you a diagnosis of MDD? Phillipa
I guess that depends upon who you speak to. William Z. Potter diagnosed me as being bipolar. That I was an ultra-rapid cycler for several years persuades me that my illness is of a bipolar diathesis.
- Scott
Posted by Phillipa on December 28, 2011, at 21:12:15
In reply to Re: DBS - Any comments? » Phillipa, posted by SLS on December 28, 2011, at 19:56:56
As devil's advocate so to speak couldn't the years and the long ago ECT have altered this? Just a thought? Phillipa
Posted by alchemy on December 28, 2011, at 21:47:47
In reply to Re: DBS - Any comments?, posted by Bob on December 27, 2011, at 21:41:07
> > > > Deep Brain Stimulation (DBS)
> > How well does DBS work? I know you received only a partial improvement. Has this improvement remained stable over time?
>
> As with any other treatment, I can't say how well it might work for another individual. It wasn't so great for me but it did effect change that meds were not doing any longer. The one thing it did was give more energy and I found myself doing things I never would have done before. Problem was, I rarely felt any better... I was just doing things.Dang, I thought it had a great record for helping depression. I have held on to it as a last resort option as well, but how do you pay for it?
Posted by jhj on December 28, 2011, at 23:52:01
In reply to Re: DBS - Any comments? » Bob, posted by alchemy on December 28, 2011, at 21:47:47
Excuse me? Why do you need to pay if you participate in clinical trials? I though It has not been approved anywhere in the world for depression and only available through clinical trials?
Posted by SLS on December 29, 2011, at 5:25:18
In reply to Re: DBS - Any comments? » SLS, posted by Phillipa on December 28, 2011, at 21:12:15
> As devil's advocate so to speak couldn't the years and the long ago ECT have altered this? Just a thought? Phillipa
That's not a bad thought. Thanks.
- Scott
Posted by SLS on December 29, 2011, at 5:29:24
In reply to Re: DBS - Any comments? » Bob, posted by alchemy on December 28, 2011, at 21:47:47
> > > > > Deep Brain Stimulation (DBS)
>
> > > How well does DBS work? I know you received only a partial improvement. Has this improvement remained stable over time?
> >
> > As with any other treatment, I can't say how well it might work for another individual. It wasn't so great for me but it did effect change that meds were not doing any longer. The one thing it did was give more energy and I found myself doing things I never would have done before. Problem was, I rarely felt any better... I was just doing things.
>
> Dang, I thought it had a great record for helping depression. I have held on to it as a last resort option as well, but how do you pay for it?
I am suspicious that some treatment failures are the result of misplacement of the wires. I would want to have the procedure for which you remain awake to tell the doctors when they hit the right spot. With the brain, there are great interindividual differences in many areas of morphology and function.Just thinking out loud...
- Scott
This is the end of the thread.
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