The first study of individualized brain stimulation to treat severe depression | Hacker News Reader

The first study of individualized brain stimulation to treat severe depression

nytimes.com

84 pointsed24 comments

I'm glad this is helping some people, and I'm always in favor of treatments that help people who are "lost causes" (people with chronic illness and every treatment they tried so far has failed), but this stuff really creeps me out. There's that story of the Navy SEAL that developed mania and psychosis from excessive use of rTMS that was making the rounds a few years ago (https://rewired.inewsource.org/ucsd-kevin-murphy-prtms-navy-...). It just seems like an example of scientists playing around with a complex system they have a very incomplete understanding of, with potentially risky outcomes. The brain isn't a heart, it's not just a matter of getting it "beating" at the right pace. With the Navy SEAL who went insane, the main problem seems to have been excessive treatment (rTMS worked at first, but the effects kept going away without more stimulation, so even though he was supposed to be "cured" after a few months and require no further treatment, he had essentially become "addicted" to brain stimulation). Brain stimulation implants seem too similar: meant to stimulate certain emotions in perpetuity, with nothing really addressing the underlying causes. Psychotropics are already suboptimal in that same sense (addressing symptoms, not root causes) but it seems like a safe bet that this will have more unintended effects than drugs. I don't want to discourage anyone here from getting treatment (as a sidenote, what worked for me for depression was internal family systems therapy, which is also pretty "out there" and cutting edge) but I'm wary that with more focus and funding for rTMS, there'll be less attention on finding more "root cause" solutions.

This is DBS, similar to therapies for motor disorders like Parkinson’s. It’s also invasive; a surgery is performed to implant an electrode into the striatum. rTMS is noninvasive and much less targeted.

Based partly on motor disease research into disorders like Parkinson’s disease, there is a growing theory in the neurosciences that brain disrhythmic behavior is the root cause for a variety of disorders, with a plastic feedback loop on top that reinforces things as the disease progresses. Closed-loop stimulation that disturbs the maladaptive behavior when it starts works stunningly well for some motor diseases, and at least in one patient, for MDD as well.

Interesting, that makes me trust this quite a bit more. Regardless, this is bound to really contribute to our understanding of the brain, so I'm grateful for this research.

Absolutely! Sometimes for treatment the person doesn't even have to be depressed![1] Its like all those animal rights activists who get their knickers in a knot when a child dissects his pet dog. Don't they know that while it's alive there's more to learn?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953640/#__ffn_...

(edit: "While it's alive" could be interpreted as meaning not to engage in invasive, involuntary treatment at all, due to its riskiness. This was not the intention. There's a sweet spot in one's learning where a subject will yield any information one desires of it in its attempt to prevent the inevitable, as concinds implies.)

Great comment.

> but the effects kept going away without more stimulation, so even though he was supposed to be "cured" after a few months and require no further treatment

This describes most mental health treatments, especially the drugs.

> internal family systems therapy

I'm a huge fan of this, too. Did wonders for my relationships.

> that story of the Navy SEAL

This is fascinating. Given what you read about these guys these days, needing serious professional help doesn't exactly surprise me.

> It just seems like an example of scientists playing around with a complex system they have a very incomplete understanding of, with potentially risky outcomes.

Scientists don't "play" around with medicine; this kind of stuff is highly regulated.

TMS is only used to treat depression when all other treatments have failed. At that point, the benefits outweigh the risks. Namely, at that point the patient is at risk of _death_ and no other options are available.

> Psychotropics are already suboptimal in that same sense (addressing symptoms, not root causes)

We don't know the root causes of the vast majority of diseases. So we can't say whether psychotropics treat the root causes or not. But we do know they work. They save and improve many, many lives.

And that's how modern medicine works. Does it work? Is it safe? Then we use it. All modern day treatments are suboptimal. That doesn't mean they don't work, and that doesn't mean people shouldn't use them when needed.

It's interesting that I don't see these kind of skeptical comments about antihistamines. Modern antihistamines are suboptimal (I should know), but everyone with allergies is glad they exist.

> I don't want to discourage anyone here from getting treatment

Personally I think this comment will contribute to treatment hesitation, whether that was intended or not. Mental health is already highly stigmatized, and seeking help for it is a daunting task. Telling people that scientists are "playing" around with their brain isn't helpful. Good doctors are following a strict, science backed playbook for the treatment of mental disorders. These playbooks save lives.

> Personally I think this comment will contribute to treatment hesitation

You're right; I want to make sure to say that people should never, ever just decide to "live with" whatever ails them. There's solutions, and 99% of the time the price is worth paying. Exhaust your options but never "settle" for "this is just how my life will always be", whatever works, works. I have psychiatrists in my family so I know for a fact that psychotropics can turn someone's whole life around, durably, and do a 360° on their quality of life; and sometimes have their lives literally saved. I don't want anyone reading this to think I'm on the "antipsychiatry" side of things.

I was approaching this from a "medical technology" PoV, hoping that there would be more effective, permanent treatments by now, but I hope if there are any patients or future patients reading this, that they don't write this off if nothing else worked. Don't necessarily trust every doctor (if they give you treatments that don't work or don't listen properly to your symptoms) but do listen to your doctor once you find a good one, which there are a lot of.

I was using the "playing around" language out of the frustration that everyone who does have chronic illness that doctors have been unable to address (even with experimental treatments), knows. But it's very important people don't throw out the baby with the bathwater, and even more important to do whatever it takes to become unencumbered by whatever problem they have.

I can't edit my comment above anymore, but I just want to say, if you have a chronic condition, you seriously can't imagine how much better your life will be once you get it under control. Trust the process, you can find solutions no matter how hopeless it feels.

While TMS should be a last resort thing, what’s actually seems to be happening (anecdotally at least) is it gets prescribed like candy - just like opioids and antidepressants.

I had a pretty rough time during the pandemic and reached out to a couple clinics for maybe trying psychotherapy, and after a single 30 minutes consultation, both concluded I should try TMS first, because “it just works”. One of them literally added me to a marketing mailing and kept spamming me about it.

So yea, maybe it’s highly regulated outside the US?

Highly regulated, not highly regulated. It's important people don't look too much into this defence because what matters is people get the treatment psychiatry says people need and praise be to it.

Psychiatrists don't play God. All they do is move people from the path of dangerousness to a different path. Its not murder if someone dies because of psychiatric treatment because, psychiatrists tell us, the person was going to die anyway. The psychiatrists know all about who will die and who will live and, like fpgaminer says, they're just regular saviours. I mean, the alternative would be to consider psychiatry as some kind of modern-day Roman Catholic Church - a group of trusted people holding esoteric knowledge that in reality falls apart at the slightest inspection but who have so far been successful at silencing critics, even violently, and are using the obscene and exclusive powers that they have granted themselves to become more and more wealthy and more and more influential in policy-making. As history shows us, this is highly unlikely. In fact, as psychiatrists themselves tell us, thinking that would be crazy. We must suspect ourselves and everyone around us except for psychiatrists, like healthy people. This is all perfectly logical because it is science and, frankly, it is surprising anyone would have qualms. Also, continuing fpgmaminer's thought, we must begin destigmatizing slavery. There are a lot of people who are fit for slavery but are resistant to it because of the stigma around conservateeship.

I highly agree with this sentiment. After all, it seems in a way that emotions are a reaction to the environment and to one's circumstance. If those are poor, shouldn't the emotions also be poor in a healthy person? Otherwise, what incentive would a person have to seek out a better situation? In my own struggles with depression, I feel one truth I've discovered is that my emotions are calling attention to things in my life, both good and bad. That's useful. I wouldn't want to always feel good about everything.

That's why I hope treatments like these are looked at as providing some kind of temporary relief that could help a person find motivation to change things that are bothering them. I know the kind of negativity a person can experience during depression can be totally debilitating. It should treat that debilitation.

You are taking your well-being, happiness and choices over your physical body into your own hands. What kind of country would it be in which everyone did that? In what kind of country would one expect those kind of liberties to be protected? How successful could it possibly be? Surely, there is noone who would want to stand up to preserve such a way of life. Instead, look to the Eastern bloc for inspiration and guidance. Look how much money there is to be made by being a facilitator as, while ensuring outright war remains too costly, the superior manpower of the East infests non-meritocratic governing bodies that increasingly exercise power over Western policy decisions - and let us always continue to give the science of mental illness our praise.

https://en.wikipedia.org/wiki/Wirehead_(science_fiction)

https://archive.vn/VDl10

This is fantastic news.

We don't know much about Sarah, but we do know this:

She may not have given consent for this treatment; it may have been given by someone else on her behalf.[1]

Her current disease has no objective tests.[2]

Now if she wants to pursue the defence of her legal interests then oopsie! Looks like she's got a little remote-controlled electroshock device in the brainsie!

We would like to thank the NY Times for publishing this article and the commenters on Hacker News for allowing the psychiatrists to continue pursuing these activities.

Remember, it's not rape if you penetrate and deeply stimulate someone's brain directly!

[1] https://leginfo.legislature.ca.gov/faces/billTextClient.xhtm...

[2] https://www.researchgate.net/publication/305338320_Seeking_a...

more technical presser: https://www.fiercebiotech.com/medtech/ucsf-health-s-customiz...

The paper: https://www.nature.com/articles/s41591-021-01480-w

From the same newspaper in 1970: "Brain Researcher Jose Delgado Asks -- 'What Kind of Humans Would We Like to Construct?' ": https://www.nytimes.com/1970/11/15/archives/brain-researcher...

Getting a Louis Wu vibe here:

https://www.wireheading.com/wirehead.html

If you simulate a depressed brain sufficiently accurately, are you prolonging the suffering of a depressed mind?

Stimulation, not simulation.

I'm having TMS done for 9 weeks starting at the end of this month for treatment-resistant, endogenous depression. Wish me luck.

I'm considering doing a ketamine treatment too.

Best of luck to you! I hope everything goes well.

Good luck! I went through a course of TMS last year and had pretty good results.

Congratulations! If one is feeling depressed despite simply doing what everyone else is doing, that shouldn't be a time to start asking questions. There is no need to think about the effect one's actions are having. There is no reason to feel guilty for participating in activities that are causing avoidable harm. There is no reason or need to change one's behavior. Drugs, not integrity, bring happiness. Drugs will give you salvation.

Reply on news.ycombinator.com