Shirah Vollmer MD

The Musings of Dr. Vollmer

Brain Stimulation: Literally Speaking

Posted by Dr. Vollmer on April 25, 2013

 

Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), and Vagus Nerve Stimulation (VNS) are all FDA approved treatments for neuropsychiatric disorders, heralding the new modality of treatment for psychiatric diagnoses. Darin Dougherty MD from the Division of Neurotherapeutics at a Harvard-affiliated hospital, presented his studies, demonstrating that when subjects were given active treatment, versus sham treatments, there was a high placebo response. To date, he has not been able to show the effectiveness of Deep Brain Stimulation, but he believes, that is because he has not determined where to place the electrode in the brain. Nevertheless, whereas drug companies used to sponsor most of the psychiatric research, now there is a lot of research sponsored by those who make these machines, such as Medtronics. Procedure-based psychiatry is the frontier, with hope of targeting a more specific area of the brain, moving us forward from ECT in which the entire brain has to seize in order to achieve the desired results. If we could localize the emotional brain, we could tickle it, and make folks feel better, or so the hope goes, for our future. In this way, this is an exciting time to be a psychiatrist, with the hope that like our medical colleagues, we hope to be able to offer our patients both pharmaceuticals and medical procedures which “fix” the underlying problem. Do I think this will put psychotherapists out of business? On the one hand, I would welcome the immediate relief that these procedures promise. On the other hand, I cannot imagine a substitute for working through difficult life decisions in a way in which one approaches junctures with thought and deep appreciation for the gravity of the decision. As always, I imagine these procedures could enhance psychotherapy by giving folks who are paralyzed by life’s traumas a way to move forward in psychotherapy so that they can navigate their world in a deeply conscious way. My work dovetails the work of those like Dr. Dougherty and so I welcome his neurotherapeutic  innovations.

4 Responses to “Brain Stimulation: Literally Speaking”

  1. Jon said

    The red flag is waving very strongly with the sentence, “to date, he has not been able to show the effectiveness of Deep Brain Stimulation, but he believes, that is because he has not determined where to place the electrode in the brain.” A question immediately comes to mind. What does Dr. Doughterty have to show that is valid? From what is described, there is nothing. Could there be something there? Yes. Has any credible work been done to show that the Division of Neurotherapeutics at a Harvard-affiliated hospital is real? Not that I read in this blog. While the credentials are real, is the research?

    This brings to mind a parallel situation in physics. John Baez, a professor of mathematics (and a mathematical physicist) at UCR, has created a Crackpot Index for physics. It can be found at this URL: http://math.ucr.edu/home/baez/crackpot.html . I wonder how Dr. Dougherty would fair on a psychiatric variation of this index.

    • Oh, Jon, I think you are being a bit harsh, or perhaps I did not accurately reflect my understanding of his presentation. He honestly presented that deep brain stimulation did not separate out from placebo, or sham treatment, such that, at this moment, it is not clear that DBS has a role in the treatment of depression, however the future, as always is uncertain. The frontier of neuromodulation has just begun, and hence there will be many fits and starts. That our field is perhaps moving away from medications and towards electrical stimulation, focused on a specific anatomical region of the brain, is quite exciting, and perhaps ground-breaking. I remain in heated suspense. Thanks.

  2. Shelly said

    The bottom line is that patients get relief with DBS. The why’s and how’s may be important questions to ask and someday, scientists will be able to answer those questions, but I think the first and foremost question is “Does it help the patient?” The answer is a resounding, “Yes!” It is true that patients get helped with these new techniques and sometimes medications alone don’t help; however, I don’t think they will ever be used as substitutes for psychotherapy. I can see them as a triad approach: new physical therapies such as ECT-medications-psychotherapy…all to help patients cope with their illnesses. In addition, mental illnesses don’t just affect the patients themselves: their families are burdened with the effects on their lives and they need support as well.

    • Yes, but the placebo response is also impressive, so we must consider that, as well. Snake oil remedies will also be appealing to many, as suggestion is very very powerful. Yes, families are hugely impacted by mental illness. That seems straight-forward to me. No one lives in a vacuum. Thanks.

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