Impossible that it would receive ethical approval, and for good reason, but it would be fantastic if such a study could be conducted as a double blinded placebo-controlled clinical trial.
The fact the patient knows she has a myriad of doctors looking at her, and that she had to undergo an extremely invasive and unique procedure means we cannot separate the intervention from the response.
My partner is defending her PhD on using Deep Brain Stimulation (DBS) i.e. a comparable device with constant current, to address severe OCD next Friday. Results are impressive (and published) on a small sample of ten patients. There’s at least three research programs that I know of (and probably a couple more if I had read the bibliography properly rather than just fix the formatting issues) with a dozen patients, some for OCD, other for other psychiatric issues. The approach is widely effective on neurological issues (Parkinson’s notably).
Her lab have scheduled double-blind trials as soon as the next patient is operated, which I think is next month, with a protocol that includes 1. implanting the device, 2. only activating the electric current for half for six months, and 3. have another psychiatrist, blinded to whether the device is active, test its effect.
There was an ethical debate on testing the device without Cognitive behavioural therapy (CBT) at the same time: CBT has a meaningful impact, and no doctor would imagine not prescribing that too, but scientifically, having patients with and without CBT, with and without DBS, etc. would allows to measure the effect of the each alone and together.
I learned about this seemingly different approach (I suspect the device is similar, but the current is triggered differently, from the vulgarisation — haven’t read the academic papers) recently, but I’d be surprised if most of the protocols didn’t extend without much complications.
Where are they implanting it in her trial? There's a big and somewhat raucous debate on 5 different (brain) targets so far, but imaging/tractography has come a long way since they started doing it.
for the CBT thing...could they just use a crossover trial design?
Big debate around that, apparently — and one vs. more locations, etc. I should remember the exact area after having to draw so many version of the interaction graphs, but not on the top of my head — did check: Bed Nucleus of Stria Terminalis.
I know one of her coauthor has doubt that the location matters that much (we are talking places that are less than a centimetre apart, at the very center of the brain for anyone who isn't up to date on their basal ganglia) and suspects that current works because it actually affects the whole area. Telling neurosurgeons that millimetres are not a matter of life-and-death apparently didn’t go too well at the latest conference… and honestly, it sounds a bit nerdy from the outside, but I’m really impressed by how much they care, and very happy that they do.
There’s been progress on imaging, but given the image quality and resolution, the very small number of patients for whom it didn’t work to compare against, I’d be surprised if they can make non-obvious judgements like “it can work as long as one of those is electrified” vs. “it works because anywhere of that area has some current of at least that much” vs. “it works because everywhere in that area has current above a low threshold, but you need to put more if you use electrodes in only some location”.
> crossover trial design
Good idea, definitely my recommendation (I implemented a lot of tests with that for on-line AB-tests to account for novelty effects); I think it has been discussed and was used before, but I remember a story of patients who got very concerned over loosing the sanity they had finally gained, and begged to get the current back. The risk of regression might lead to worst outcomes. That’s the different with say, tremors from Parkinson’s: sure they are impossible to live with, but if you are confident they can be switched on and off, they become an annoying party trick. Same as a prosthetic leg: you need it to walk but if you have to take it off, you can. Mental health doesn't have the same tangibility: you are not yourself anymore without it? It’s hard to explain but it drives a lot of the trickier ethical questions in psychiatry.
Check the literature because I could have made the patients up, or it could be a speculation from the ethics committee. But as the device gets more common, there will be better stats & methodology. I suspect that, to get from a research exception to a diagnostic recommendation, they will need to do investigate to recommend either switching it off in case of concern, how, how fast, which levels, when to stop lowering, etc.) or advise against any reduction, or recommend having the device removed… Crossover could be helpful in that context.
No, it's a stimulating electrode implanted surgically in selected brain targets.
The difference is: TMS is inaccurate/broad/hard to target, and wears off either when you shut off the TMS or a few days to weeks later. Think a weaker version of ECT. DBS allows focus on specific brain targets, and the effect lasts for the lifetime of the electrodes/device.
> Impossible that it would receive ethical approval
> The fact the patient knows she has a myriad of doctors looking at her, and that she had to undergo an extremely invasive and unique procedure means we cannot separate the intervention from the response.
Deep brain stimulation has undergone many such trials[1]. I'm not sure why this would be such an ethical barrier when we have much more risky and permanent procedures (various surgeries, for example) that can undergo ethical trials.
Methodology summary from trial linked below:
"We conducted a 6-month double-blind, randomized, sham-controlled crossover study in implanted patients with previous severe TRD who experienced full remission after chronic stimulation. After more than 3 months of stable remission, patients were randomly assigned to 2 treatment arms: the ON-OFF arm, which involved active electrode stimulation for 3 months followed by sham stimulation for 3 months, and the OFF-ON arm, which involved sham stimulation for 3 months followed by active stimulation for 3 months."
typically this is done via sham stim. i.e. implant both groups, but don't turn on the control group for the blinded phase. Helps that DBS technique has had 40 years or so to refine itself so its adverse-effect rate is reasonably well known and established.
Can we have nice things? A technology to alter brain function to actually make peoples lives better and not be abused to make them also complacent, obedient, work twice with half the pay without complaining and buy the highest bidding brand.
Eh, sorry. We probably could have, but you just gave me all these great ideas.
Then again, if I’ve learned anything from the past decade, forget all that working harder stuff, I’ll just figure put how to sell advertising straight into your brain implant, don’t mind me while I take some of the most talented programmers in the world to do this.
> [..] abused to make them also complacent, obedient, work twice with half the pay without complaining and buy the highest bidding brand.
Not to worry, the new brain implant provides immediate relief from negative feelings about the brain implant! You'll be hysterically cackling in no time on your way to work at your third minimum wage job in the mines, with a protein snack made of an assortment of bugs.
In all seriousness, this is highly concerning, especially in conjunction with the powers that have been given so easily during the COVID pandemic.
Imagine in 10 years time it is declared that there is a 'depression pandemic', and for the better health of yourself and those around you, you must get your anti-depression implant in order to return back to work, and without your implant passport you will not be allowed into bars, restaurants, etc. Those that have already had the implant call you 'anti-Science' and publicly ridicule you as a second-class citizen. The President at the time publicly declares "our patience is running thin", as pressure ramps up to combat yet another infectious wave of depression.
The government promises "the implant will only be used to track and trace contact with those suspected of having depression", but soon the police realise that such technology could also be used in "exceptional" criminal cases, where your state of mind around the place of the crime can be submitted as evidence to your involvement. Once there is some acceptance and legal standing, the use becomes more and more common place. Eventually some smart people realize that there is some pattern of behaviour for people who are about to commit a crime, and so pre-crime arrests and thought-crimes arise.
In the city I live, people couldn't even be convinced to wear a cloth mask for basically any reason, and people picketed an elementary school because the district implemented a mask recommendation.
I can imagine your scenario, it's an interesting enough thought for some dystopian fiction, but I don't think the clear one-to-one analogy between an infectious disease and crippling depression work in any way at all. In the COVID case, it's an infectious disease with some possible long-term damage, high rate of infection, relatively moderate risk of death, and a scramble to try to contain or slow the spread. I don't see how any of that can be compared to depression, a non-contagious disorder that very often destroys all quality of life in the sufferers.
Honestly, I don't see any gain in this incredible pessimism. A brain implant seems to have some potential to allow some people to have hope in successfully living a life that isn't controlled by a cloud of grey, and the first worry is in a dystopian government using it to brain control the public, because there is a pattern of behavior in how governments desperately tried to control a pandemic in the past?
> but I don't think the clear one-to-one analogy between an infectious disease and crippling depression work in any way at all.
>> Depression isn’t contagious in the same way the flu is, but moods and emotions can spread. Have you ever watched a friend laugh so hard that you started laughing? Or listened to a co-worker complain for so long that you started feeling negative, too? In this way, moods — and even depressive symptoms — can be contagious.
>> We’ll explain how it works, what the science says, and what to do if you feel like you’ve “caught” depression from a loved one.
>> Researchers call it a variety of things, including network phenomenon, social contagion theory, and group emotional contagion theory.
Honestly, if a brain implant was proven to be as safe as vaccination, and could get me to be happy while working 3 jobs in a mine and eating bugs. I probably would sign up.
Also, pretending this whole argument isn't a pathos charged slippery slope analogy. Why would I go bars, restaurants, etc if there was a risk I could expose others to depression. Which I must assume is somehow contagious now, and somewhat fatal? Seems awfully inhumane and immoral to subject people to this new somewhat lethal contagious depression.
More generally though, why is it highly concerning? Are you afraid of hypotheticals? Or does that just feel like what you have to say to rationalize your existing fears about the ongoing pandemic, and societies unmeasured response?
> Honestly, if a brain implant was proven to be as safe as vaccination, and could get me to be happy while working 3 jobs in a mine and eating bugs. I probably would sign up.
I'd shoot the nearest billionaire to encourage the others.
I think it's misleading to the point of maliciousness to call depression contagious. The phrase "ideas are contagious" is a great concept; because it's obvious on it's face that it's a rhetorical concept, and not really contagious. The average human however wouldn't be able to fairly determine if depression was actually contagious, or if it's just a rhetorical device. It's especially confounding when you consider that depression is both a symptom and disease. I recall a study linking depression to gut bacteria, which is without a doubt contagious. But that's not depression that's contagious, that's a bacterial infection; that has depression as a symptom.
That's just the long winded way of saying yes, I think depression as a concept should be considered contagious, but only philosophically. It's wrong to say depression is contagious if the discussion is remotely medical.
>Honestly, if a brain implant was proven to be as safe as vaccination, and could get me to be happy while working 3 jobs in a mine and eating bugs. I probably would sign up.
Aldous Huxley's Brave New World is a setting based on a very similar concept, it'll probably be an old hat to most here on HN but I strongly encourage everyone to read it if they haven't already (along with The Doors of Perception). Huxley makes a lot of very good objections to why this "technology to make people happy with their social status" is actually a deeply dystopian notion.
Like the Savage, I don't want to live in perfectly happy world where government writ forces me to live my life on rails set for me before my birth, a world where people can only colour within the lines drawn out by the elite and are completely incapable of even conceiving a world outside the one they're born into because they're medically engineered to love their social station and be perfectly happy in the caste they were born into. In the Savage's words: "I don't want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin". I'd rather be authentically unhappy than artificially happy because someone else told me I have to be or I'm defective.
Obviously in the case of depression and other mental illnesses it's different, you're aiming to treat a disease rather than make people slavishly compliant with a socio-political establishment. I don't object at all to the former, but I very much object to the latter if there's no way out for people who'd rather not be manipulated into social submission.
I always thought Huxley's book completely failed as a critique. The savage in the story is quite literally that, a take on the noble savage myth. We're supposed to buy that he's more free because he's just like, authentic man, similar to Orwell's obsession with chocolate and fountain pens in 1984.
The dumb worker peons always seemed silly because any sufficiently advanced control society would at the very least lift people up to be more useful, his characters are comical references to socialists (Lenina etc), it's so trite.
It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive. Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations? The book never goes beyond "oh no the family is dead, orgy porgy!"
The book's plagued by the same provincial pastoralism you find in almost any British upper-class writer, be it Orwell, Tolkien, Huxley or C.S. Lewis.
>We're supposed to buy that he's more free because he's just like, authentic man, similar to Orwell's obsession with chocolate and fountain pens in 1984.
We're supposed to buy that he's more free because he's not been hypnotically conditioned from birth (ie without his consent) to love his role in society and his place in its rigid caste hierarchy. The "civilised" people in Brave New World aren't less free because simply because they're civilised as the trope usually goes, they're less free because their social superiors have deliberately prevented them from ever learning notions of freedom to begin with - to them consumption is the highest form of existence because it's all they've ever known. Yes it leans fairly heavily on the "noble savage" trope but I don't think he's as one-dimensional as you make him out to be.
>The dumb worker peons always seemed silly because any sufficiently advanced control society would at the very least lift people up to be more useful
Why would they bother lifting people up in the context of Brave New World? The leadership's whole thing is that the ratios of the various castes are strictly controlled and most of humanity are intentionally engineered to be simpletons who love their roles and little else. The book even addresses this idea of lifting everyone up to be more useful directly, it mentions an island where everyone was in the "alpha" caste and says it was a disaster as far as Brave New World's leadership was concerned. Their argument was pretty much "why make everyone intelligent ubermensch even though we can when we still need people to empty the bins and sweep the streets - jobs these people would be profoundly unhappy doing?".
>It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive.
Huxley wasn't a prohibitionist, in fact he wrote about his experiences taking mescaline at length and was seen as an important author by the psychedelic counterculture of the '1960s. He did think that psychedelic use ought to be limited in contrast to the likes of say Timothy Leary who wanted to see them used in a more widespread fashion but I don't think Brave New World is particularly based on a moral panic. You can criticise hedonism and what Huxley would have considered cheap and ultimately hollow attempts at happiness without necessarily being a moraliser in my opinion.
I'll give you the "Lenina" thing though, I always thought that was a bit cheap.
>Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations? The book never goes beyond "oh no the family is dead, orgy porgy!"
I have to disagree here, the point of the book isn't that these technologies are bad per se. The argument is that these technologies could potentially be used to create a dystopia that's very touchy-feely on the surface and supposedly concerned with making everyone happy but in reality creates an inauthentic happiness, a happiness where humanity is stripped of its very essence and turned into little more than livestock for the consumerist meat grinder.
In Brave New World the leadership take the view that it's fine for authorities to manipulate and coerce people as long as they're subjectively happy about it, criticising this isn't particularly moralistic in my opinion. Brave New World isn't some sexual hangup-free utopia either - its leaders actively discourage people forming exclusive relationships because they see it as a threat to their highly controlled social order. It's the logical conclusion of what countries like the USSR were doing in the '30s, weakening family ties so that children would inform on their parents and so on. Huxley is presenting the destru...
The sexual freedom and drugs are the only positives in BNW that make it a utopia. Everything else in there is dystopian. Why is “freeing” women from reproductive obligations a good thing?
> I always thought Huxley's book completely failed as a critique
Dystopian fiction is a intended as a warning sign of a particular dangerous potebtiay failure mode of existing/developing societal elements, not an analytical critique weighing alternate potential outcomes of the same elements.
So, yeah, it fails at being what it very much is not intended as; no surprise there.
> It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive.
Its illustrating a failure mode, noy trying to map the entire potential result space. Exploring how the same components could succeed is...very much not the point.
> Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations?
Because the point isn't “How this could work out well”. That's not the goal.
> Honestly, if a brain implant was proven to be as safe as vaccination, and could get me to be happy while working 3 jobs in a mine and eating bugs. I probably would sign up.
You would really give over so much control over your person?
> More generally though, why is it highly concerning? Are you afraid of hypotheticals? Or does that just feel like what you have to say to rationalize your existing fears about the ongoing pandemic, and societies unmeasured response?
Regarding the concern, the kind of control this technology puts upon another person is extremely powerful. I could for example imagine a torture device where it simply zaps you when you have any positive thought - how many weeks will it take to make you submissive? How long till you'll carry out that assassination attempt?
The hypothetical scenario serves as commentary on our currently eroding freedoms (whether you believe it is done for positive or negative reasons). It also shows a viable slippery path for where such a future could exist - each one of the mechanisms I suggested are not pulled from thin air, they all have basis in recent developments.
> You would really give over so much control over your person?
You'll not that I never said I'd give up my anatomy, just that I'd be happy regardless of whatever tasks or life I'm living. And yes, absolutely. If I was freed from negative emotions and experience. I could instead spend my time on what I want to, or need to. You didn't state what I think you meant to wrongly imply that it was a mind control device.
> Regarding the concern, the kind of control this technology puts upon another person is extremely powerful. I could for example imagine a torture device where it simply zaps you when you have any positive thought - how many weeks will it take to make you submissive?
I don't know, my current understanding of torture is you can break a person, meaning get them to give up on life. But can't actually ever control how they behave. I have no reason to believe that would change with better technology. Say you do break me, destroy my ability to do anything. I'd have no motivation to do anything at all ever. People suffering from such a severe breakdown or depression lose the ability to function. You can do that with torture now, "new technology allows us do to something faster" isn't impressive, nor revolutionary.
> How long till you'll carry out that assassination attempt?
Never... humans have tried to create manchurian candidates already. It has always failed. Failed so drastically that we've never even come close to getting any human to willingly do something outside what they'd do through positive motivation. So you haven't given me a reason to suspect otherwise.
> The hypothetical scenario serves as commentary on our currently eroding freedoms (whether you believe it is done for positive or negative reasons). It also shows a viable slippery path for where such a future could exist - each one of the mechanisms I suggested are not pulled from thin air, they all have basis in recent developments.
Let's pretend for the sake of this argument, that I do agree with you that we're losing additional freedoms that we have. And setting aside the reasons. (For the record, I don't. Arguments that this is a new scary thing we all should be afraid of are made without merit, with a single exception.) I'm assuming you're familiar with one, but not both versions of the slippery slope fallacy. I'll try to refute both.
The first being `A will lead to B; B is bad; therefor A is bad`. That's a fallacy, it's not true. A could be good or bad, and B could be good or bad. But that doesn't mean A and B is bad. Billy is a mass murder, he's caught and sent to jail. Him being sent to jail means he's not allowed to do what he really wants, that's bad. A leads to B, B is bad. A and B happening together are still better than not happening.
The other; `A might lead to B; B might lead to C, C is SO SO much worse than A and B could possibly be; thus A is bad and should be avoided`. This is the more common one, but it's logically flawed because you both have to prove that C is worse than A (which you haven't in this case), *AND* prove that A MUST lead to C. Which you also haven't done. Requiring people to prove that they have made an attempt to ensure they're not infectious/dangerous before being allowed to interact with a community, is not the same as requiring invasive treatment for a non-contagious disease. And you haven't given me a reason to think anyone's trying to apply that logic to it. One's infectious, the other isn't. You've said nothing to change my mind on this. Just because someone might say or do something stupid, isn't a reason to believe it will happen.
There's a reason these fallacies are common, they seem like they could be true, and they're scary. The probability of it happening * how bad it could be = how scary it feels. The problem is, just because they're something that could hap...
We can't. Depression is your brain's reaction to not being able to pick and maintain long-term goals for prolonged time. And the increased number of depressed people in the past decades is an indication that something about our society is going wrong.
Dealing with it without resolving the underlying cause is effectively turning people into obedient work force that has accepted its fate.
So the sadness that accompanied working a min wage job full time evenings and weekends through 6 years of university was my inability to pick and maintain my goals, not economic stress and lack of sleep. I feel so daft.
It was a clear signal from your subconsciousness that you were putting time and effort in something that didn't bring long-term value. If we lived in a pre-corporate era, you could have considered a trade, or helping run a small business, building rapport with the owner, or something else that would have had more meaning. Such things build up character, you sort of gain velocity and habits that help you propel yourself further later in life.
Except we destroyed that with low interest rates and turning a blind eye for anticompetitive behavior. Now most people are replaceable cogs that ran out of goals that would motivate them. That's the real, and very big problem.
I hope the degree was worth it, because otherwise you have wasted 6 years of your life. Paying for some administrators' trips to Hawaii with your student debt. And that depression feeling was a very clear early warning that could have helped you prevent that.
Depression is the result of an overactive amygdala and has little to do with goal achievement. That can be caused by genetics and/or a wide gamut of environmental and experiential inputs over time. I would think the goal of any intervention is to help people lead more fulfilling lives and prevent self-harm rather than to create a compliant workforce.
Think of all of the people who were born like that. Think of the people who had intensely traumatic experiences at a young age such that their systems grew abnormally. Ascribing a lack of self-discipline to those and many others who face that awful affliction is both arrogant and ignorant.
Yes that is one very narrow and specific cause of the symptoms of depression. but it is by no means the only thing that causes depression in humans.
but the implication that attempting to treat depression without solving the external underlying cause perpetuates the negative stigma around depression treatment and makes it harder for people to consider and accept treatment. Which has been shown over and over and over and over and over again to be required for people with severe depression to be able to take any action to improve their life.
Even that's only including the people who are depressed from some external cause that they can take action on. loss of a loved one is something that causes depression and if left untreated can spiral down into a state of despair that people are unable to dig themselves back out of alone.
> Yes that is one very narrow and specific cause of the symptoms of depression. but it is by no means the only thing that causes depression in humans.
I think it's a problem of terminology really. Grief and depression look very similar to an outside observer and are often conflated, but there are several other mental states that all look pretty similar and are labeled under the umbrella of 'depression' too. Many of them are relatively temporary.
I think the kind of depression parent is talking about is the one that's behind the significant and rising percentage of people being diagnosed with, and treated for, depression. Over 10% of the population in the US is on an SSRI, and that cannot be a good sign for society.
Oh, there are plenty of ways to dampen the symptoms short term without paying a dime to the healthcare system. One good strenuous hike works wonders. Not talking about forcing yourself to go join a public speaking club or something similar. This involves willpower, but willpower can be trained, just like muscles. We should encourage that and praise that, and help people find their ways of achieving that, rather then cultivating learned helplessness on a national scale.
No, it doesn't. I've cycled for 50km on weekends, I've "hiked" 17km (walked between cities lol) a few times to try it. Yeah, it feels good at the end. And then it's back to the normal depressed state.
Agreed. I am also an avid bike rider and 50mi is my standard Saturday morning ride (the more hills the better!). It does feel great, both while doing it and for the better part of the day afterwards. There's a clarity in it that I lack in my day-to-day existence. But it never lasts.
I've had a tough time lately, mentally, and went on a bike tour with my dog to a state park 40 miles away for 2 days. Over 100lbs of load. Hiked a good 10 miles while there. Rode back. It felt great and life had clarity for all of 24 hours after.
There's a lot of good reasons to exercise, but alleviating depression isn't one of them in my experience.
While I usually abhor reductionist conclusions, I find this comment refreshing and hopefully useful to others. Depression isn't simply "lack of serotonin" nor "a series of unfortunate events".
There's a theory of a strong association between clinical depression and https://en.wikipedia.org/wiki/Learned_helplessness and hopefully society will move forward to enable people to live better lives.
I call it the ADD-anxiety-depression circle. Can't do what you want, get anxious about it, get depressed from it, repeat.
But there are other causes for depression. It can simply be a brain with too little of a neurotransmitter or other. SSRIs actually work great for many people, Gabapentin for others.
Even in the above example, "ADD" can easily be replaced with "poverty" and you can add some drug addiction in the mix.
After years, it just becomes chronic, your new normal and it's very doubtful that you can be normal without serious external help.
Fortunately, or unfortunately depending on how you view it, brains don't seem to work like that.
The likelihood of DBS being able to turn someone into an ideal worker/consumer is about the same as it being able to turn a Parkinson's patient into an Olympic athlete.
I would generally agree with this...the electrodes and microcontrollers we have tend to be relatively crude.
BUT...I would say apathy as a broad symptom/syndrome is known to be associated w/ an untreated Parkinsonian state...so if some enterprising postdoc somehow finds a target nucleus that improves apathy w/ macro stimulating electrodes in the near future...we could all be wrong..
That might be possible, but it's likely more of a person to person difference than something that can be reliably used.
Even with people with PD, whether and how well DBS will work is variable, and even after it's put in, assuming it works for someone, programing is about finding a good balance between beneficial effects and unwanted side effects.
Even if there is a target to improve apathy, it'll likely come at the expense of some other unwanted side effects.
The problem w/ PD-DBS is...the practice of implanting and programming the gizmos is much less standardized that it should be. Yes, there is some patient to patient variability...but you can kind of predict what will happen and how the patient will respond simply by mapping the anatomical location of the electrodes using Lead DBS or FSL or ANTS. The folks with well placed electrodes - the pro-movement/anti-tremor effect is remarkably consistent. The folks who either are implanted a few millimeters outside of the targeted nucleus, or roll in the door with some bizarre setting...not so much...
That being said, I have heard for less measurable symptoms, i.e. OCD or depression...DBS implantation and programming is much more inexact, as you describe.
I think it depends on the person. My mom's experience isn't that uniform. Every MDS sees her high pulse width (for PD I guess), is like "Hold my beer.", and tries something that works out worse than the settings she's had since she first got DBS in 2005.
It is night and day for tremor, but it also has significant trade-offs. Granted, it could be that the targeting wasn't ideal to begin, after 15+ years she needs her leads redone, or something else, but from what I've seen it really is a set of trade-offs.
I remember watching a video by a guy who just got DBS talking about something similar with a researcher and I'll edit this post if I can find it.
it is hard to say...anecdotally, I've seen generally that the further the electrode is located away from the posterior subthalamic nucleus, the higher the PW is needed to achieve any effect. Maybe the electrode probably needs it to send current over further distances. But it may be helpful to map things out if imaging is available.
Targeting has probably come a long way too. I remember pulling old MRI's from cases done in 2003 or so, and they just look so fuzzy and crude compared with modern machines...
Good thing that everyone's getting depressed! A brain implant has come to the rescue! Now if we could only find a wealthy entity who could be a good Samaritan and help fund it for the people who need it most ...
Never mind that "cackling laughter" isn't a sign that depression is gone, nor is depression a bad thing on the whole. The causes for depression are well known, so why are we trying to electrocute our brain into not acting in it's own best interests?
Fair. Just like that I saw a little pushback to the usual fanboy reaction to brain implants.
I'm sure there are plenty of valid use cases including this one. Just think we should take caution with technology so we also don't normalize artificial happiness.
We've been normalizing artificial happiness for millennia with alcohol and other drugs, it only makes sense for humans to continue experimenting with such things.
If a device that isn’t plugged directly into my brain makes me happy, is it no longer artificial because it’s being experienced via typical sensory inputs? Or can an external device also cause this “artificial” happiness?
I’m quite depressed. I think the world I live in makes me depressed. I would take a treatment that made me not care about dismal and grim things, if that would make me stop feeling so much pain.
How convenient it would be for governments to be able to make the population content with their dystopia. No need to fix wages or living conditions. Just zap their brains in to liking it.
On the other hand, if one wasn't depressed by most of modern society because some other part of modern society had intervened, could we really say that modern society was bad?
He means depression caused by living within a system of exploitative economic relations which curtail peoples ability for free and authentic expression, a fundamental need of all human beings.
Why are some people better at understanding technology or people? Why are some people able to do competitive bodybuilding? Why are some people geniuses? Why are some people paralyzed? Why do some people have deadly diseases or allergies?
Everyone's different, plus evolution. Left alone, the modern depressed would just die off soon enough.
> [snip] nor is depression a bad thing on the whole.
> The causes for depression are well known, so why are we trying to electrocute our brain into not acting in it's own best interests?
While I agree with the sentiment that this study isn't a great study, these three remarks and the tone of your comment make it clear you have zero personal experience with depression. I hope you never experience it- it's hell. No amount of descriptive imagery or keen adjectives can ever convey what it actually feels like, so I understand how people who've never been in its jaws can be so dismissive. After all, just like it's hard to tell that stuffed inside a ballerina's blood-filled shoes are cramped, broken, _aching_ feet, it's hard to wrap your head around pain that isn't readily seen, much less try to empathize with the person feeling it. So I get it. I understand why you're so dismissive.
The only way I can think of to describe depression is to describe suicidal ideation: when you have a moment, go to your garage, get a hammer, and smash your thumb with it. Not a pleasant thought, right? I'd be willing to bet that if you were to legitimately try, you'd find it almost impossible; the instinct for self preservation is one of the most basic, powerful instincts. Now, imagine a situation where you're in so much pain that this instinct is completely overwhelmed and you actively try to kill yourself to stop it, a situation where you cannot believe you'll ever be able to be happy again, a situation that feels truly hopeless.
That's depression. While suicidal ideation is one of the extremes, depression is something that drives a person to that point.
In all honesty, I sincerely hope neither you nor your loved ones ever have to face such despair. "That they experienced loss is not a gain, and that they experienced pain is not a victory."
It's possible to express a negative view about a technology without diminishing the struggles of the people it's intended to help. A little kindness goes a long way.
> you have zero personal experience with depression. I hope you never experience it- it's hell.
Do not even begin to assume what I have been through. The difference you might be failing to realise in your long essay on the behalf of others is that to go "through" something is to come out the other side.
You've already made your assumptions so I highly doubt you'll listen to me much further, not do I want to gain "e-points" by listing out all my ailments. I can assure you however, that I have received professional help for both depression and other mental conditions in my life.
The difference being, that my doctors and I were able to look at the root causes, and able to work out of it. Meds were weaned off as soon as I was put on them, and not looked at as a source of pharmacy income the rest of my life. Nor, now, a brainwashing device that can zap you for your hourly dose of Facebook ads. Thanks science.
By a large margin, the reason people get depressed is because their life is at odds with their expectations. The father is depressed because they want freedom. The teen is depressed because they want to feel genuine love, etc.
The only way out of that is to calm (which meds can temporarily help) then figure out a plan to make the life they do want, then actively working towards that, while managing expectations and inevitable disappointments. Sunlight and physical activity goes a long way in putting the body's regulation system back into action.
Everyone just gets stuck up on "ok, meds." And don't follow through with the rest of it - actually improve your life - and expects everything to be better somehow. Painkillers while keeping the hand on the stove.
It's not the conclusions I've
drawn based on your own dismissive words that will prevent me from putting stock in what you say, it's the way you seem to believe that it's impossible for others to have experiences that differ from yours. I'm not the only one making assumptions here, the difference is that I'm making assumptions about you based on what you say- you're making assumptions about the whole of humanity based on your own experience. It really blows my mind that you're convinced that what worked for you is a panacea. Of course, saying things like "Tldr get fuxked" doesn't lend your words any strength either, so I guess I shouldn't be so surprised at such a limited perspective; forgive me if I stop giving you my attention. I hope you have a pleasant day nonetheless- best of luck to you and your loved ones.
If i asked you to point out a flaw in my reasoning you'd say "but I'm not well versed in the /science/" - I'm making assumptions based purely off that /science/.
If you're saying that it's all just goobly-gook and random chance and everyone's different then I'd see that you'd have no problem injecting yourself with microchips to make yourself feel better, tailored by your ad preferences.
It really blows my mind that you're thinking this is the most valiant hill to die on; like depression is some great enigma that's plagued humanity. It's as common as a headache. People like you stop others from getting better. "yeah you're right, some people are unsavable, definitely need meds. meds are the only way out right now. no don't listen to others who've gotten better. some people definitely have no hope and definitely need meds"
That's as silly as saying a headache causes you to chop your head off.
If you look at a screen all day, and get a headache, what do you do. Painkillers and back to the screen? Drink water and rest a bit? Pull out a hacksaw?
If you liken depression to a headache, it demonstrates we're not talking about the same thing. Depression is not the same as sadness.
Analogies only take us so far, but a far better one would be physical pain so severe that, like severely depressed patients, the victims want to kill themselves to end it. Think torture, which is often how depressed patients describe their own intrusive thoughts.
Well, it's an N-1 study/case report. The next step is to get Francis Collins or Elon to cough up another R01 grant's worth of monopoly bux to fund the larger trial...
Which came first, the shape of the body or the depression? Because whenever I don't work out I get pretty damn depressed. I think we humans are built to get adrenaline releases regularly or to suffer from chemical imbalances. Running, weight lifting, whatever it may be, you need to do strenuous activity or you're gonna have a bad time.
It says something when your first response to a story about a severely disabled woman is to judge the "shape of her body."
If you only get "depressed" after not working out for a while, you've never actually experienced the sort of depression that the article is talking about.
Have you ever heard of the para-olympics? There are tons of disabled folk who workout their upper body if their lower body is disabled. Average folk, not genetically gifted either, if you goto bodybuilding.com forums and search 'disabled' you can marvel at their accomplishments.
I've experienced a general meaningless and wanting to die after not working out for months. Working out is the best antidepressant (aside from hallucinogens) that nature has to offer us. It's hard to get out of the slump and get started, but once one does, it really does help out one's brain.
So don't tell me I haven't experienced clinical depression when I've been diagnosed with it many times..
This woman may have issues other than her obesity but I can guarantee that the obesity and lack of physical activity is a large reason for her depression. You don't get to walrus proportions by eating human portions and by exercising even sparingly unless you have some type of endocrine system issue.
On the contrary, studies show money up to a certain level certainly does *correlate with happiness, and abject poverty with stress and sadness. Kinda silly to even debate about something so obvious and backed by rigorous academic studies.
* Correlation is not absolution. Individuals (and outliers) exist. It merely means a strong coupling in the values of two different measurements in a population.
So.. you are not providing an argument? Are you overweight because of this lack of effort in your life and thus you feel an impulsive sense to defend what you feel is in some sense an attack on your kin? It all makes sense now. Thank you for illuminating the plight of the Häagen-Dazs.
When I was a student maybe 5-10 years ago, I got to attend a conference on brain/computer interface research as part of an extracurricular.
There were lots of interesting posters and products, but what really grabbed me was one of the headlining presentations. A group of researchers had learned how to use deep brain stimulation to do exactly this: provide immediate relief to a severely depressed patient.
The video was dramatic, but I found it creepy. One second, the person looked sunk in misery as they talked about their bleak outlook on the world. The next second, they started smiling and saying that everything seemed alright. The on/off procedure repeated a few times with the same effect: misery, relief, misery, relief.
I would take a brain implant to help me type faster, or treat a degenerative brain disease. But something that acted like a rapid mood-altering drug? Never, not after seeing that video.
> I’m imagining an app on your phone where on a day you’re feeling down, you turn it on for a bit.
That’s not really what this brain implant does. The patient was experiencing certain obsessive thought loops leading to depression. The brain implant was targeting at disrupting the thought loops allowing for recovery.
A brain implant that directly induced positive mood would be something else entirely. I suspect it could quickly lead to addictive behaviors as patients give up on naturally improving their condition and learn to rely on pressing the button for more happy thoughts instead.
To quote G'Kar: "we are all the sum of our tears. Too little and the ground is not fertile and nothing can grow there. Too much, the best of us is washed away."
The problem with using such a device at will when merely feeling down (that is, things that are not clinical depression) is that life will become boring, monotonous, and in a way, almost futile. What's the point of anything any more if we can just "be happy" at the press of a button? Why bother actually solving whatever made you unhappy in the first place? How can you still appreciate the good moments? How can you still build deep social relationships if your ability to make someone else happy? (Or why even seek out such relationships in the first place?)
Occasional use won't be a huge problem, but such a device would quickly become addictive at least psychologically, if not psychically. It's impossible to say what will happen, but I don't think it will be very positive.
So my answer would be "no".
Aside: the idea is not entirely new; e.g. in Brave New World there is a "happy drug" with more or less the same effects that you describe.
> What's the point of anything any more if we can just "be happy" at the press of a button? Why bother actually solving whatever made you unhappy in the first place? How can you still appreciate the good moments? How can you still build deep social relationships if your ability to make someone else happy? (Or why even seek out such relationships in the first place?)
You described drugs !
And I can feel an incoming issue for the society. If anyone can be happy with the press of a button, why bother about, say… improving society, fighting human exploitation (they’re so happy to work), fighting climate change (at least we get 6 months summers, what a relief).
But I’m not rejecting that this appliance could be very useful if well used, because depression also is an issue for the society, for the ones affected, and because it probably increases criminality by a lot.
Well, it looks like humanity is going through a lot of hard topics to tackle.
Drugs sure as hell never made me happy; they just made me feel weird and uncomfortable. Maybe I tried the wrong drugs shrug
> But I’m not rejecting that this appliance could be very useful if well used, because depression also is an issue for the society, for the ones affected
Oh yes, sure, I think we can get a lot of value out of this. But I think there's a very big difference between "depression" and "feeling down".
“At that moment, when I had the TV sound off, I was in a 382 mood; I had just dialed it. So although I heard the emptiness intellectually, I didn't feel it. My first reaction consisted of being grateful that we could afford a Penfield mood organ. But then I realized how unhealthy it was, sensing the absence of life, not just in this building but everywhere, and not reacting—do you see? I guess you don't. But that used to be considered a sign of mental illness; they called it 'absence of appropriate affect.' So I left the TV sound off and I sat down at my mood organ and I experimented. And I finally found a setting for despair. So I put it on my schedule for twice a month; I think that's a reasonable amount of time to feel hopeless about everything, about staying here on Earth after everybody who's smart has emigrated, don't you think?”
― Philip K. Dick, Do Androids Dream of Electric Sheep?
I would absolutely use it. The current state of mental health care feels like the wild west at times. I want to imagine a technology like this would have less side effects than what we currently use.
I don't know where we would have to draw a line for when to use it. When you miss the bus and were late to an important meeting. When you lost a pair of your favorite headphones. When you lost something you feel very sentimental about. When you lose a pet or a loved one. When you see something traumatic. When you experience something traumatic.
What would feeling down mean in a world where happiness is a click of a button away?
An interesting thought experiment is if you could recognize and interrupt other thought patterns to change behavior and preferences because you want to, but have a hard time implementing the change.
Obvious example is addiction - there's some evidence that LSD and Psilocybin 'cure' alcoholics, I'd bet a targeted affect similar to this depression targeting could in theory work.
Maybe other things too, making it easier to practice or less afraid of trying new things - overcoming other obstacles. Obviously there are risks, but the positives are interesting to wonder about.
I am honestly glad this sort of researching is leading the way towards a quantitative measure of depression. I am not sure if we'll get to the level of a finger prick blood test that we use for diabetes, but research like this makes me think more positively of the future.
I know the medical healthcare community is slow to change to an evidence research based approach because "we do it because it's shown to work in the past". Doctors overriding novel research papers and going based on intuition is something deeply ingrained in healthcare culture.
I hope and am optimistic that this changes with the current generation of doctors where research papers and UpToDate is a few clicks away.
Depression is subjective because it's defined by symptoms rather than quantitative tests, but that's a limitation of the current technology.
Psychiatry is one of the few fields of medicine that reminds me of when the answer to a lot of ailments used to be bloodletting. Some drugs like benzos and lithium help stabilize mood at the cost of cognitive functioning. Those aren't drugs of the past, they're used by doctors today.
The zapping a brain with electrodes, sounds liked a more selective way of using ECT. I am sure the patients in these clinical trials understand the risks and I understand we're not in the age of medicine where lobotomies are done negligently or from a patriarchal view of how a man and woman should behave.
I think the first major step to ridding the idea and stigma around mental health, such as when people casually call themselves depressed or say they're addicted to shopping, is to quantify it.
I hate the idea that suicidal thoughts and attempts are the benchmark that the general public uses to gauge the severity of depression.
This might not be a perfect study and it's so specialized to the individual. But even if this study shows which biomarkers from which parts of the brain are correlated with what kind of depressive symptoms, that would be leaps and bounds ahead of what current clinical psychiatry looks like.
Edit:
I just remembered the extrapolating that some people are doing in the rest of the thread. The Penfield Mood Organ from the world of Philip K. Dick's, Do Android Dreams of Electric Sheep. The first chapter describes one of the characters dialing the device to make herself feel deep despair and depression for a set amount of time twice a month to feel human. It's an interesting read if people haven't yet, Blade Runner is the movie based loosely based on it. They are different enough that the book is worth reading even if you've seen the movie.
> The zapping a brain with electrodes, sounds liked a more selective way of using ECT.
This method is entirely different than ECT. The researchers used an electrode to disrupt specific ruminative thoughts that were causing, or at least perpetuating, the patient’s depression.
It’s more analogous to traditional therapy methods applied by brute force at the physical level. Whereas traditional therapy would train patients to identify and break negative thoughts loops, this patient was apparently unable to do so. The brain implant physically disrupts part of the brain that contributes to those loops, opening the door for recovery from the self-defeating process.
I have done research in the computational healthcare field to try to optimize and make the placement of electrodes easier for surgeons by analyzing spike neuron activity that were recorded during an actual surgery that had place.
The electrodes in DBS by purpose continuously release electric pulses at target locations in the brain. ECT, from my understanding is a short full brain excitation using electric pulses. The location of where the electrodes are places on the outside of the head change what part of the brain is targeted.
This research is a middle ground where they are using the same technology to send short "six second" impulses to a very targeted part of the brain.
I don't agree that this is entirely different from ECT.
Having my own history with depression and paranoia bordering anxiety I can only encourage ppl to look into food intolerances.
Good treatment is just one part of it, my guess is that if the symptoms are treated, something else will go wrong long term.
Exactly that, and depression is rarely just the one issue, or rarely has just the one cause; if you're depressed because of e.g. poverty, just taking pills won't solve the root cause. I mean it might break a cycle and be a first step towards a better life of course, but that cycle could be broken by better circumstances as well.
Did your problems get solved by eliminating certain foods and if so, how did you go about narrowing down the culprits?
One problem with depression, as mentioned in the article, is that it's hard to define exactly what the problem is (there's no "depression center" in the brain) which means treating the symptoms is often the only option.
Well, I would say that by eliminating foods is only part of the problem and can guarantee you success. I think changing the way we eat and live is better.
For starters, you could eliminate the extra-processed foods from your diet and add more natural sources of food.
Then you could follow a regiment of 2-3 meals a day. Put the protein heavy + fatty foods in the first meal of the day and the carbs heavy foods as last meals.
Make sure you are eating enough nutrients. Don't be afraid of salt.
Add lots of fermented food cause there is a link with improving the gut and its ability to fight inflammations.
Add movement and exercise, and make them a habit. Get a fitness buddy.
Make sure you are a getting regular good sleep.
I would recommend you a great podcast series called the Huberman lab, where this Stanford professor offers great insights about how the body works and what are the latest news from various research fields.
You eat the carbs to spike your insulin and help you fall asleep as the glucose is in your body is depleted. If you time it right and have a stable circadian rhythm your natural melatonin production will kick in and knock you out for deep sleep. [Source: Andrew Huberman]
I am not aware of any good reason for worrying about when your basal metabolism is lowest. If you want to lose weight do intermittent fasting and get into ketosis.
Severe (read: Not seasonal, not time of day influenced, not due to e.g. your spouse dying) depression is something you need to go to a therapist for. Advice on the internet (for this specific thing) is something for after all doctors and medication fails you, or as an addendum to an already well-understood treatment formulated by someone that sees folks with your problems every day.
I wish the field of psychiatry was mature and used different words for depression caused by your environment and life stressors vs depression caused by brain chemistry vs depression caused by ignoring nutrition. It's not fair to compare these types of depression as worse or less worse and each would need different kinds of treatment protocols. The current definition is just based on symptoms and trying therapy and medication until something works.
There is a lot of promising research being done about the relationship between your gut microbiome and depression and other mental health issues.
Hopefully more research is done in populations across the world because it seems like currently most of the literature is focused on a western population.
"High-fat consumption not only leads to obesity but also causes widespread inflammation of body systems. The gut microbiome may alter the harmful effects of the high-fat diet, improving mood and behavior. By modulating gut microbiome composition through proper nutrition and probiotics, we also help decrease anxiety and depression [4]." [0]
I do hope all of this research will bubble up to solid advice and / or legislation though; saying "just fix your diet!" has big "thanks I'm cured" energy because it's a pretty vague statement. Plus, especially in the US, getting 'good' food is a challenge; there's many "food deserts" in the US where the only source of food is the local fast food chains. And - from an outsider's point of view, correct me if I'm wrong - things like fresh fruit and vegetables are reserved for the 'elitist' grocery store chains like Whole Foods.
I completely understand and agree with you. Public policy has a hard time matching scientific guidelines, it's hard to generalize at a global scale.
I agree about the "thanks I'm cured" energy and that's why I included citations to show that it does help some people. It's worth trying. It's not the only reason for depression, but it is the easiest and has the least side effects in terms of treatment options. No constant cost of therapy and no drugs and side effects. But if you have multiple things causing issues with mental health, you're going to crave the unhealthy food to cope. That makes adherence to a healthy diet harder too.
I think the most promising recent legislation regarding food has been Oaxaca, Mexico banning sugary drinks and junk food for those under the age of 18 in 2020. [0] Which also has specific research backing that age group. [1]
There's might be some debate eventually about high-fat vs high-sugar being worse, but over-processed junk food is a good catch all I think. Neither is healthy for a gut biome although high-fat/lipid is talked about more often. [2]
I personally have a theory that high-sugar is worse than high-fat. But I have no research I can point to backing it other than the idea that low carb diets seem to do better than low fat diets. Even though diets at the end of the day it's calories in, calories out, in this context not all calories are equal. I think self measuring blood sugar levels are going to be the next big thing for diet trends.
I do agree that fresh fruits and vegetables are harder to find in places of lower socioeconomic status, but that's a more complex issue than only "elite" grocery stores reserving the fresh fruit.
GMO fruit is just as good as organic. The marketing in the west makes it seem like organic is the only way to go, but frozen fruits and non organic vegetables are just as healthy if not healthier. [3] You generally have to use harsher pesticides for organic foods anyway to get good yield. [4]
The bigger issue is that time is a also luxury and preparing a healthy meal takes time.
People who can afford that time are also affluent enough to be able to shop at elite places like Whole Foods. The supply chain for fresher fruits and vegetables means the cost is higher so it only sells at 'elite' chains where there is a demand and people can afford it.
If you're working long hours, maybe two jobs, you're not going to have time to cook, the cheapest reasonable meal is the processed fast food place.
I don't have a solution but with enough research, public policy won't be able to ignore the detrimental cost of high-sugar and high-fat and highly processed foods. One day I think we'll look at food today the way we see nicotine and cigarettes of the past, and I'm not alone in that sentiment.
Almost any grocery store in the US has fresh fruit and vegetables, even Walmart. Not every location in the US has an easily accessible grocery store. Further US food subsidies are huge but don’t apply to fruits or vegetables so their relatively more expensive.
Food banks are also significantly less likely to carry fresh vegetables vs canned ones.
Frozen fruits and vegetables aren't bad. And you don't necessarily need fresh ones, you can also eat canned ones. And in any case, just eating a better macro diet with a multivitamin works better than munching on twinkies all day or hunting for elusive vegetables.
> I wish the field of psychiatry was mature and used different words for depression caused by [...]
They may use the same umbrella diagnosis, but when you seek treatment different causes of depression are all separately tested for. Food-mediated things are not top of mind, not in the least because nutrition is poorly understood and incredibly personal besides. That's something much easier investigated on your own (something you are taught the tools for when you seek therapy).
In my experience the difference between a fast (but incomplete) diagnosis and a much slower (but comprehensive) one is going to a single psychiatrist vs an institute. Your point is reasonable, of course. There is big variability between doctors.
> I wish the field of psychiatry was mature and used different words for depression caused by [...]
Isn't this covered by "situational depression" (adjustment disorder with depressed mood) VS "clinical depression" (major depressive disorder), and the fact that diagnosis entails excluding physical conditions that cause similar symptoms?
None of the various depressive disorders (nor other psychiatric disorders) deal with defining a cause, but with describing a set of symptoms.
The way I think about it is that there are a number of conditions that can cause serious depression, some of which are known and have a straight-forward treatment, for instance, thyroid and hormonal issues, certain sleeping disorders, and certain nutrition issues.
If the cause of the mental issues is unknown, you're left with treating the symptoms, which is certainly better than nothing, but often inexact and trial and error. Thus it makes sense to knock out any probable known causes when starting treatment before assuming an unknown cause.
My personal experience was when I was first diagnosed is that I had my vitamin levels checked, thyroid checked, had some sleep labs, and everyone recommended losing weight and exercise.
I think the interesting thing about this paper is:
1) it is a closed loop approach, using the Neuropace device to stimulate based on local field potential recordings from sensing electrodes listening...somewhere (once I bug my librarian to pull the PDF for me I'll look more closely). The biggest effort for depression so far was the Mayberg/Emory group's constant waveform stim in the subcallosal cingulate (medtronic devices which output a set voltage/pulse duration/frequency, which have to be changed manually). W/ mixed results...
Neuropace has been out for, what, 10+ years out now, so it's not the latest/greatest tech but maybe good enough for what they are trying to do.
2) Busy year for Eddie Chang's group. They published the brain LFP -> synthetic speech paper a few months ago...
I don't think our (U.S.A.) penal system cares enough to even bother with the procedure if it ever gains FDA approval.
I have been told the Psychiatric Care at most prisons is atrocious. The prison in my county has had a running want ad for a Psychiatrist since the 80's.
I'm referencing San Quentin.
I once heard a perp confess to a crime that would send him to prison for life with one caveat, and it was, "I just want to be sent to a prision anywhere that has a good Psychiatric Unit."
The article indicates that previously she was unable to care for herself. While not exactly fully objective, i feel like - do you need someone else to take care of you, is not a purely subjective measure.
i'm happy for the people whom it is going to help, especially with the stuff like Parkinson's. I'm just kind of surprised that our brain is so "simple" that such simple things do work.
152 comments
[ 0.23 ms ] story [ 120 ms ] threadThe fact the patient knows she has a myriad of doctors looking at her, and that she had to undergo an extremely invasive and unique procedure means we cannot separate the intervention from the response.
Her lab have scheduled double-blind trials as soon as the next patient is operated, which I think is next month, with a protocol that includes 1. implanting the device, 2. only activating the electric current for half for six months, and 3. have another psychiatrist, blinded to whether the device is active, test its effect.
There was an ethical debate on testing the device without Cognitive behavioural therapy (CBT) at the same time: CBT has a meaningful impact, and no doctor would imagine not prescribing that too, but scientifically, having patients with and without CBT, with and without DBS, etc. would allows to measure the effect of the each alone and together.
I learned about this seemingly different approach (I suspect the device is similar, but the current is triggered differently, from the vulgarisation — haven’t read the academic papers) recently, but I’d be surprised if most of the protocols didn’t extend without much complications.
for the CBT thing...could they just use a crossover trial design?
I know one of her coauthor has doubt that the location matters that much (we are talking places that are less than a centimetre apart, at the very center of the brain for anyone who isn't up to date on their basal ganglia) and suspects that current works because it actually affects the whole area. Telling neurosurgeons that millimetres are not a matter of life-and-death apparently didn’t go too well at the latest conference… and honestly, it sounds a bit nerdy from the outside, but I’m really impressed by how much they care, and very happy that they do.
There’s been progress on imaging, but given the image quality and resolution, the very small number of patients for whom it didn’t work to compare against, I’d be surprised if they can make non-obvious judgements like “it can work as long as one of those is electrified” vs. “it works because anywhere of that area has some current of at least that much” vs. “it works because everywhere in that area has current above a low threshold, but you need to put more if you use electrodes in only some location”.
> crossover trial design
Good idea, definitely my recommendation (I implemented a lot of tests with that for on-line AB-tests to account for novelty effects); I think it has been discussed and was used before, but I remember a story of patients who got very concerned over loosing the sanity they had finally gained, and begged to get the current back. The risk of regression might lead to worst outcomes. That’s the different with say, tremors from Parkinson’s: sure they are impossible to live with, but if you are confident they can be switched on and off, they become an annoying party trick. Same as a prosthetic leg: you need it to walk but if you have to take it off, you can. Mental health doesn't have the same tangibility: you are not yourself anymore without it? It’s hard to explain but it drives a lot of the trickier ethical questions in psychiatry.
Check the literature because I could have made the patients up, or it could be a speculation from the ethics committee. But as the device gets more common, there will be better stats & methodology. I suspect that, to get from a research exception to a diagnostic recommendation, they will need to do investigate to recommend either switching it off in case of concern, how, how fast, which levels, when to stop lowering, etc.) or advise against any reduction, or recommend having the device removed… Crossover could be helpful in that context.
The difference is: TMS is inaccurate/broad/hard to target, and wears off either when you shut off the TMS or a few days to weeks later. Think a weaker version of ECT. DBS allows focus on specific brain targets, and the effect lasts for the lifetime of the electrodes/device.
> The fact the patient knows she has a myriad of doctors looking at her, and that she had to undergo an extremely invasive and unique procedure means we cannot separate the intervention from the response.
Deep brain stimulation has undergone many such trials[1]. I'm not sure why this would be such an ethical barrier when we have much more risky and permanent procedures (various surgeries, for example) that can undergo ethical trials.
Methodology summary from trial linked below:
"We conducted a 6-month double-blind, randomized, sham-controlled crossover study in implanted patients with previous severe TRD who experienced full remission after chronic stimulation. After more than 3 months of stable remission, patients were randomly assigned to 2 treatment arms: the ON-OFF arm, which involved active electrode stimulation for 3 months followed by sham stimulation for 3 months, and the OFF-ON arm, which involved sham stimulation for 3 months followed by active stimulation for 3 months."
1. https://pubmed.ncbi.nlm.nih.gov/25652752/
See methods section https://n.neurology.org/content/88/16_Supplement/P5.016
Then again, if I’ve learned anything from the past decade, forget all that working harder stuff, I’ll just figure put how to sell advertising straight into your brain implant, don’t mind me while I take some of the most talented programmers in the world to do this.
Yeah, you aint't even gotta think about it bro.
Not to worry, the new brain implant provides immediate relief from negative feelings about the brain implant! You'll be hysterically cackling in no time on your way to work at your third minimum wage job in the mines, with a protein snack made of an assortment of bugs.
In all seriousness, this is highly concerning, especially in conjunction with the powers that have been given so easily during the COVID pandemic.
Imagine in 10 years time it is declared that there is a 'depression pandemic', and for the better health of yourself and those around you, you must get your anti-depression implant in order to return back to work, and without your implant passport you will not be allowed into bars, restaurants, etc. Those that have already had the implant call you 'anti-Science' and publicly ridicule you as a second-class citizen. The President at the time publicly declares "our patience is running thin", as pressure ramps up to combat yet another infectious wave of depression.
The government promises "the implant will only be used to track and trace contact with those suspected of having depression", but soon the police realise that such technology could also be used in "exceptional" criminal cases, where your state of mind around the place of the crime can be submitted as evidence to your involvement. Once there is some acceptance and legal standing, the use becomes more and more common place. Eventually some smart people realize that there is some pattern of behaviour for people who are about to commit a crime, and so pre-crime arrests and thought-crimes arise.
The future has never looked so safe!
I can imagine your scenario, it's an interesting enough thought for some dystopian fiction, but I don't think the clear one-to-one analogy between an infectious disease and crippling depression work in any way at all. In the COVID case, it's an infectious disease with some possible long-term damage, high rate of infection, relatively moderate risk of death, and a scramble to try to contain or slow the spread. I don't see how any of that can be compared to depression, a non-contagious disorder that very often destroys all quality of life in the sufferers.
Honestly, I don't see any gain in this incredible pessimism. A brain implant seems to have some potential to allow some people to have hope in successfully living a life that isn't controlled by a cloud of grey, and the first worry is in a dystopian government using it to brain control the public, because there is a pattern of behavior in how governments desperately tried to control a pandemic in the past?
>> Depression isn’t contagious in the same way the flu is, but moods and emotions can spread. Have you ever watched a friend laugh so hard that you started laughing? Or listened to a co-worker complain for so long that you started feeling negative, too? In this way, moods — and even depressive symptoms — can be contagious.
>> We’ll explain how it works, what the science says, and what to do if you feel like you’ve “caught” depression from a loved one.
>> Researchers call it a variety of things, including network phenomenon, social contagion theory, and group emotional contagion theory.
https://www.healthline.com/health/is-depression-contagious
You're killing grandma by being unhappy.
Also, pretending this whole argument isn't a pathos charged slippery slope analogy. Why would I go bars, restaurants, etc if there was a risk I could expose others to depression. Which I must assume is somehow contagious now, and somewhat fatal? Seems awfully inhumane and immoral to subject people to this new somewhat lethal contagious depression.
More generally though, why is it highly concerning? Are you afraid of hypotheticals? Or does that just feel like what you have to say to rationalize your existing fears about the ongoing pandemic, and societies unmeasured response?
I'd shoot the nearest billionaire to encourage the others.
If enough of those people are killed the rest of them will get the memo that they'll live longer if they hoarded less wealth.
That's just the long winded way of saying yes, I think depression as a concept should be considered contagious, but only philosophically. It's wrong to say depression is contagious if the discussion is remotely medical.
Aldous Huxley's Brave New World is a setting based on a very similar concept, it'll probably be an old hat to most here on HN but I strongly encourage everyone to read it if they haven't already (along with The Doors of Perception). Huxley makes a lot of very good objections to why this "technology to make people happy with their social status" is actually a deeply dystopian notion.
Like the Savage, I don't want to live in perfectly happy world where government writ forces me to live my life on rails set for me before my birth, a world where people can only colour within the lines drawn out by the elite and are completely incapable of even conceiving a world outside the one they're born into because they're medically engineered to love their social station and be perfectly happy in the caste they were born into. In the Savage's words: "I don't want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin". I'd rather be authentically unhappy than artificially happy because someone else told me I have to be or I'm defective.
Obviously in the case of depression and other mental illnesses it's different, you're aiming to treat a disease rather than make people slavishly compliant with a socio-political establishment. I don't object at all to the former, but I very much object to the latter if there's no way out for people who'd rather not be manipulated into social submission.
The dumb worker peons always seemed silly because any sufficiently advanced control society would at the very least lift people up to be more useful, his characters are comical references to socialists (Lenina etc), it's so trite.
It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive. Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations? The book never goes beyond "oh no the family is dead, orgy porgy!"
The book's plagued by the same provincial pastoralism you find in almost any British upper-class writer, be it Orwell, Tolkien, Huxley or C.S. Lewis.
We're supposed to buy that he's more free because he's not been hypnotically conditioned from birth (ie without his consent) to love his role in society and his place in its rigid caste hierarchy. The "civilised" people in Brave New World aren't less free because simply because they're civilised as the trope usually goes, they're less free because their social superiors have deliberately prevented them from ever learning notions of freedom to begin with - to them consumption is the highest form of existence because it's all they've ever known. Yes it leans fairly heavily on the "noble savage" trope but I don't think he's as one-dimensional as you make him out to be.
>The dumb worker peons always seemed silly because any sufficiently advanced control society would at the very least lift people up to be more useful
Why would they bother lifting people up in the context of Brave New World? The leadership's whole thing is that the ratios of the various castes are strictly controlled and most of humanity are intentionally engineered to be simpletons who love their roles and little else. The book even addresses this idea of lifting everyone up to be more useful directly, it mentions an island where everyone was in the "alpha" caste and says it was a disaster as far as Brave New World's leadership was concerned. Their argument was pretty much "why make everyone intelligent ubermensch even though we can when we still need people to empty the bins and sweep the streets - jobs these people would be profoundly unhappy doing?".
>It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive.
Huxley wasn't a prohibitionist, in fact he wrote about his experiences taking mescaline at length and was seen as an important author by the psychedelic counterculture of the '1960s. He did think that psychedelic use ought to be limited in contrast to the likes of say Timothy Leary who wanted to see them used in a more widespread fashion but I don't think Brave New World is particularly based on a moral panic. You can criticise hedonism and what Huxley would have considered cheap and ultimately hollow attempts at happiness without necessarily being a moraliser in my opinion.
I'll give you the "Lenina" thing though, I always thought that was a bit cheap.
>Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations? The book never goes beyond "oh no the family is dead, orgy porgy!"
I have to disagree here, the point of the book isn't that these technologies are bad per se. The argument is that these technologies could potentially be used to create a dystopia that's very touchy-feely on the surface and supposedly concerned with making everyone happy but in reality creates an inauthentic happiness, a happiness where humanity is stripped of its very essence and turned into little more than livestock for the consumerist meat grinder.
In Brave New World the leadership take the view that it's fine for authorities to manipulate and coerce people as long as they're subjectively happy about it, criticising this isn't particularly moralistic in my opinion. Brave New World isn't some sexual hangup-free utopia either - its leaders actively discourage people forming exclusive relationships because they see it as a threat to their highly controlled social order. It's the logical conclusion of what countries like the USSR were doing in the '30s, weakening family ties so that children would inform on their parents and so on. Huxley is presenting the destru...
Dystopian fiction is a intended as a warning sign of a particular dangerous potebtiay failure mode of existing/developing societal elements, not an analytical critique weighing alternate potential outcomes of the same elements.
So, yeah, it fails at being what it very much is not intended as; no surprise there.
> It's also full of conservative moral panic, for example the sexual freedom and alternative experiences through synthetic drugs never get a serious treatment as potentially positive.
Its illustrating a failure mode, noy trying to map the entire potential result space. Exploring how the same components could succeed is...very much not the point.
> Why not celebrate the fact that you can create children synthetically and women are freed from reproductive obligations?
Because the point isn't “How this could work out well”. That's not the goal.
You would really give over so much control over your person?
> More generally though, why is it highly concerning? Are you afraid of hypotheticals? Or does that just feel like what you have to say to rationalize your existing fears about the ongoing pandemic, and societies unmeasured response?
Regarding the concern, the kind of control this technology puts upon another person is extremely powerful. I could for example imagine a torture device where it simply zaps you when you have any positive thought - how many weeks will it take to make you submissive? How long till you'll carry out that assassination attempt?
The hypothetical scenario serves as commentary on our currently eroding freedoms (whether you believe it is done for positive or negative reasons). It also shows a viable slippery path for where such a future could exist - each one of the mechanisms I suggested are not pulled from thin air, they all have basis in recent developments.
You'll not that I never said I'd give up my anatomy, just that I'd be happy regardless of whatever tasks or life I'm living. And yes, absolutely. If I was freed from negative emotions and experience. I could instead spend my time on what I want to, or need to. You didn't state what I think you meant to wrongly imply that it was a mind control device.
> Regarding the concern, the kind of control this technology puts upon another person is extremely powerful. I could for example imagine a torture device where it simply zaps you when you have any positive thought - how many weeks will it take to make you submissive?
I don't know, my current understanding of torture is you can break a person, meaning get them to give up on life. But can't actually ever control how they behave. I have no reason to believe that would change with better technology. Say you do break me, destroy my ability to do anything. I'd have no motivation to do anything at all ever. People suffering from such a severe breakdown or depression lose the ability to function. You can do that with torture now, "new technology allows us do to something faster" isn't impressive, nor revolutionary.
> How long till you'll carry out that assassination attempt?
Never... humans have tried to create manchurian candidates already. It has always failed. Failed so drastically that we've never even come close to getting any human to willingly do something outside what they'd do through positive motivation. So you haven't given me a reason to suspect otherwise.
> The hypothetical scenario serves as commentary on our currently eroding freedoms (whether you believe it is done for positive or negative reasons). It also shows a viable slippery path for where such a future could exist - each one of the mechanisms I suggested are not pulled from thin air, they all have basis in recent developments.
Let's pretend for the sake of this argument, that I do agree with you that we're losing additional freedoms that we have. And setting aside the reasons. (For the record, I don't. Arguments that this is a new scary thing we all should be afraid of are made without merit, with a single exception.) I'm assuming you're familiar with one, but not both versions of the slippery slope fallacy. I'll try to refute both.
The first being `A will lead to B; B is bad; therefor A is bad`. That's a fallacy, it's not true. A could be good or bad, and B could be good or bad. But that doesn't mean A and B is bad. Billy is a mass murder, he's caught and sent to jail. Him being sent to jail means he's not allowed to do what he really wants, that's bad. A leads to B, B is bad. A and B happening together are still better than not happening.
The other; `A might lead to B; B might lead to C, C is SO SO much worse than A and B could possibly be; thus A is bad and should be avoided`. This is the more common one, but it's logically flawed because you both have to prove that C is worse than A (which you haven't in this case), *AND* prove that A MUST lead to C. Which you also haven't done. Requiring people to prove that they have made an attempt to ensure they're not infectious/dangerous before being allowed to interact with a community, is not the same as requiring invasive treatment for a non-contagious disease. And you haven't given me a reason to think anyone's trying to apply that logic to it. One's infectious, the other isn't. You've said nothing to change my mind on this. Just because someone might say or do something stupid, isn't a reason to believe it will happen.
There's a reason these fallacies are common, they seem like they could be true, and they're scary. The probability of it happening * how bad it could be = how scary it feels. The problem is, just because they're something that could hap...
Dealing with it without resolving the underlying cause is effectively turning people into obedient work force that has accepted its fate.
Except we destroyed that with low interest rates and turning a blind eye for anticompetitive behavior. Now most people are replaceable cogs that ran out of goals that would motivate them. That's the real, and very big problem.
I hope the degree was worth it, because otherwise you have wasted 6 years of your life. Paying for some administrators' trips to Hawaii with your student debt. And that depression feeling was a very clear early warning that could have helped you prevent that.
Think of all of the people who were born like that. Think of the people who had intensely traumatic experiences at a young age such that their systems grew abnormally. Ascribing a lack of self-discipline to those and many others who face that awful affliction is both arrogant and ignorant.
but the implication that attempting to treat depression without solving the external underlying cause perpetuates the negative stigma around depression treatment and makes it harder for people to consider and accept treatment. Which has been shown over and over and over and over and over again to be required for people with severe depression to be able to take any action to improve their life.
Even that's only including the people who are depressed from some external cause that they can take action on. loss of a loved one is something that causes depression and if left untreated can spiral down into a state of despair that people are unable to dig themselves back out of alone.
I guess those people should just be happy right?
I think it's a problem of terminology really. Grief and depression look very similar to an outside observer and are often conflated, but there are several other mental states that all look pretty similar and are labeled under the umbrella of 'depression' too. Many of them are relatively temporary.
I think the kind of depression parent is talking about is the one that's behind the significant and rising percentage of people being diagnosed with, and treated for, depression. Over 10% of the population in the US is on an SSRI, and that cannot be a good sign for society.
In order to treat causes of depression successfully in the long term, it can be incredibly helpful to dampen the symptoms short term.
I've had a tough time lately, mentally, and went on a bike tour with my dog to a state park 40 miles away for 2 days. Over 100lbs of load. Hiked a good 10 miles while there. Rode back. It felt great and life had clarity for all of 24 hours after.
There's a lot of good reasons to exercise, but alleviating depression isn't one of them in my experience.
No. This is not reasonable to say, because exercise does not "work wonders". It works a little and it makes you feel a little better, that is it.
There's a theory of a strong association between clinical depression and https://en.wikipedia.org/wiki/Learned_helplessness and hopefully society will move forward to enable people to live better lives.
But there are other causes for depression. It can simply be a brain with too little of a neurotransmitter or other. SSRIs actually work great for many people, Gabapentin for others.
Even in the above example, "ADD" can easily be replaced with "poverty" and you can add some drug addiction in the mix.
After years, it just becomes chronic, your new normal and it's very doubtful that you can be normal without serious external help.
The likelihood of DBS being able to turn someone into an ideal worker/consumer is about the same as it being able to turn a Parkinson's patient into an Olympic athlete.
BUT...I would say apathy as a broad symptom/syndrome is known to be associated w/ an untreated Parkinsonian state...so if some enterprising postdoc somehow finds a target nucleus that improves apathy w/ macro stimulating electrodes in the near future...we could all be wrong..
Even with people with PD, whether and how well DBS will work is variable, and even after it's put in, assuming it works for someone, programing is about finding a good balance between beneficial effects and unwanted side effects.
Even if there is a target to improve apathy, it'll likely come at the expense of some other unwanted side effects.
That being said, I have heard for less measurable symptoms, i.e. OCD or depression...DBS implantation and programming is much more inexact, as you describe.
It is night and day for tremor, but it also has significant trade-offs. Granted, it could be that the targeting wasn't ideal to begin, after 15+ years she needs her leads redone, or something else, but from what I've seen it really is a set of trade-offs.
I remember watching a video by a guy who just got DBS talking about something similar with a researcher and I'll edit this post if I can find it.
Targeting has probably come a long way too. I remember pulling old MRI's from cases done in 2003 or so, and they just look so fuzzy and crude compared with modern machines...
https://qualiacomputing.com/2016/08/20/wireheading_done_righ...
Never mind that "cackling laughter" isn't a sign that depression is gone, nor is depression a bad thing on the whole. The causes for depression are well known, so why are we trying to electrocute our brain into not acting in it's own best interests?
This whole study is completely absurd.
Most of modern society is a reason to be deppressed, but lets fix slavery induced depression with a dopamine triggering brain implant.
I'm sure there are plenty of valid use cases including this one. Just think we should take caution with technology so we also don't normalize artificial happiness.
If a device that isn’t plugged directly into my brain makes me happy, is it no longer artificial because it’s being experienced via typical sensory inputs? Or can an external device also cause this “artificial” happiness?
Could you elaborate on what you mean by that?
What’s the reason this is happening? I’m yet to understand this..
Everyone's different, plus evolution. Left alone, the modern depressed would just die off soon enough.
> [snip] nor is depression a bad thing on the whole.
> The causes for depression are well known, so why are we trying to electrocute our brain into not acting in it's own best interests?
While I agree with the sentiment that this study isn't a great study, these three remarks and the tone of your comment make it clear you have zero personal experience with depression. I hope you never experience it- it's hell. No amount of descriptive imagery or keen adjectives can ever convey what it actually feels like, so I understand how people who've never been in its jaws can be so dismissive. After all, just like it's hard to tell that stuffed inside a ballerina's blood-filled shoes are cramped, broken, _aching_ feet, it's hard to wrap your head around pain that isn't readily seen, much less try to empathize with the person feeling it. So I get it. I understand why you're so dismissive.
The only way I can think of to describe depression is to describe suicidal ideation: when you have a moment, go to your garage, get a hammer, and smash your thumb with it. Not a pleasant thought, right? I'd be willing to bet that if you were to legitimately try, you'd find it almost impossible; the instinct for self preservation is one of the most basic, powerful instincts. Now, imagine a situation where you're in so much pain that this instinct is completely overwhelmed and you actively try to kill yourself to stop it, a situation where you cannot believe you'll ever be able to be happy again, a situation that feels truly hopeless. That's depression. While suicidal ideation is one of the extremes, depression is something that drives a person to that point.
In all honesty, I sincerely hope neither you nor your loved ones ever have to face such despair. "That they experienced loss is not a gain, and that they experienced pain is not a victory."
It's possible to express a negative view about a technology without diminishing the struggles of the people it's intended to help. A little kindness goes a long way.
Depression, like most other forms pain, is a warning signal. Unplugging warning signals usually leads to problems.
Do not even begin to assume what I have been through. The difference you might be failing to realise in your long essay on the behalf of others is that to go "through" something is to come out the other side.
You've already made your assumptions so I highly doubt you'll listen to me much further, not do I want to gain "e-points" by listing out all my ailments. I can assure you however, that I have received professional help for both depression and other mental conditions in my life.
The difference being, that my doctors and I were able to look at the root causes, and able to work out of it. Meds were weaned off as soon as I was put on them, and not looked at as a source of pharmacy income the rest of my life. Nor, now, a brainwashing device that can zap you for your hourly dose of Facebook ads. Thanks science.
By a large margin, the reason people get depressed is because their life is at odds with their expectations. The father is depressed because they want freedom. The teen is depressed because they want to feel genuine love, etc.
The only way out of that is to calm (which meds can temporarily help) then figure out a plan to make the life they do want, then actively working towards that, while managing expectations and inevitable disappointments. Sunlight and physical activity goes a long way in putting the body's regulation system back into action.
Everyone just gets stuck up on "ok, meds." And don't follow through with the rest of it - actually improve your life - and expects everything to be better somehow. Painkillers while keeping the hand on the stove.
Tldr get fuxked
If you're saying that it's all just goobly-gook and random chance and everyone's different then I'd see that you'd have no problem injecting yourself with microchips to make yourself feel better, tailored by your ad preferences.
It really blows my mind that you're thinking this is the most valiant hill to die on; like depression is some great enigma that's plagued humanity. It's as common as a headache. People like you stop others from getting better. "yeah you're right, some people are unsavable, definitely need meds. meds are the only way out right now. no don't listen to others who've gotten better. some people definitely have no hope and definitely need meds"
Depression leads to suicide. The indirect suggestion that suicide is in a person's best interest is ridiculous.
If you look at a screen all day, and get a headache, what do you do. Painkillers and back to the screen? Drink water and rest a bit? Pull out a hacksaw?
Analogies only take us so far, but a far better one would be physical pain so severe that, like severely depressed patients, the victims want to kill themselves to end it. Think torture, which is often how depressed patients describe their own intrusive thoughts.
If you only get "depressed" after not working out for a while, you've never actually experienced the sort of depression that the article is talking about.
I've experienced a general meaningless and wanting to die after not working out for months. Working out is the best antidepressant (aside from hallucinogens) that nature has to offer us. It's hard to get out of the slump and get started, but once one does, it really does help out one's brain.
So don't tell me I haven't experienced clinical depression when I've been diagnosed with it many times..
This woman may have issues other than her obesity but I can guarantee that the obesity and lack of physical activity is a large reason for her depression. You don't get to walrus proportions by eating human portions and by exercising even sparingly unless you have some type of endocrine system issue.
Plenty of examples of rich people in good shape who killed themselves or said they have depression.
A implies B does not mean it's contraposition is true. That is, that (not A) implies (not B.)
https://en.wikipedia.org/wiki/Raven_paradox
On the contrary, studies show money up to a certain level certainly does *correlate with happiness, and abject poverty with stress and sadness. Kinda silly to even debate about something so obvious and backed by rigorous academic studies.
* Correlation is not absolution. Individuals (and outliers) exist. It merely means a strong coupling in the values of two different measurements in a population.
I’m imagining an app on your phone where on a day you’re feeling down, you turn it on for a bit.
When I was a student maybe 5-10 years ago, I got to attend a conference on brain/computer interface research as part of an extracurricular.
There were lots of interesting posters and products, but what really grabbed me was one of the headlining presentations. A group of researchers had learned how to use deep brain stimulation to do exactly this: provide immediate relief to a severely depressed patient.
The video was dramatic, but I found it creepy. One second, the person looked sunk in misery as they talked about their bleak outlook on the world. The next second, they started smiling and saying that everything seemed alright. The on/off procedure repeated a few times with the same effect: misery, relief, misery, relief.
I would take a brain implant to help me type faster, or treat a degenerative brain disease. But something that acted like a rapid mood-altering drug? Never, not after seeing that video.
That’s not really what this brain implant does. The patient was experiencing certain obsessive thought loops leading to depression. The brain implant was targeting at disrupting the thought loops allowing for recovery.
A brain implant that directly induced positive mood would be something else entirely. I suspect it could quickly lead to addictive behaviors as patients give up on naturally improving their condition and learn to rely on pressing the button for more happy thoughts instead.
The problem with using such a device at will when merely feeling down (that is, things that are not clinical depression) is that life will become boring, monotonous, and in a way, almost futile. What's the point of anything any more if we can just "be happy" at the press of a button? Why bother actually solving whatever made you unhappy in the first place? How can you still appreciate the good moments? How can you still build deep social relationships if your ability to make someone else happy? (Or why even seek out such relationships in the first place?)
Occasional use won't be a huge problem, but such a device would quickly become addictive at least psychologically, if not psychically. It's impossible to say what will happen, but I don't think it will be very positive.
So my answer would be "no".
Aside: the idea is not entirely new; e.g. in Brave New World there is a "happy drug" with more or less the same effects that you describe.
You described drugs !
And I can feel an incoming issue for the society. If anyone can be happy with the press of a button, why bother about, say… improving society, fighting human exploitation (they’re so happy to work), fighting climate change (at least we get 6 months summers, what a relief).
But I’m not rejecting that this appliance could be very useful if well used, because depression also is an issue for the society, for the ones affected, and because it probably increases criminality by a lot.
Well, it looks like humanity is going through a lot of hard topics to tackle.
> But I’m not rejecting that this appliance could be very useful if well used, because depression also is an issue for the society, for the ones affected
Oh yes, sure, I think we can get a lot of value out of this. But I think there's a very big difference between "depression" and "feeling down".
― Philip K. Dick, Do Androids Dream of Electric Sheep?
I would absolutely use it. The current state of mental health care feels like the wild west at times. I want to imagine a technology like this would have less side effects than what we currently use.
I don't know where we would have to draw a line for when to use it. When you miss the bus and were late to an important meeting. When you lost a pair of your favorite headphones. When you lost something you feel very sentimental about. When you lose a pet or a loved one. When you see something traumatic. When you experience something traumatic.
What would feeling down mean in a world where happiness is a click of a button away?
Obvious example is addiction - there's some evidence that LSD and Psilocybin 'cure' alcoholics, I'd bet a targeted affect similar to this depression targeting could in theory work.
Maybe other things too, making it easier to practice or less afraid of trying new things - overcoming other obstacles. Obviously there are risks, but the positives are interesting to wonder about.
I know the medical healthcare community is slow to change to an evidence research based approach because "we do it because it's shown to work in the past". Doctors overriding novel research papers and going based on intuition is something deeply ingrained in healthcare culture.
I hope and am optimistic that this changes with the current generation of doctors where research papers and UpToDate is a few clicks away.
Depression is subjective because it's defined by symptoms rather than quantitative tests, but that's a limitation of the current technology.
Psychiatry is one of the few fields of medicine that reminds me of when the answer to a lot of ailments used to be bloodletting. Some drugs like benzos and lithium help stabilize mood at the cost of cognitive functioning. Those aren't drugs of the past, they're used by doctors today.
The zapping a brain with electrodes, sounds liked a more selective way of using ECT. I am sure the patients in these clinical trials understand the risks and I understand we're not in the age of medicine where lobotomies are done negligently or from a patriarchal view of how a man and woman should behave.
I think the first major step to ridding the idea and stigma around mental health, such as when people casually call themselves depressed or say they're addicted to shopping, is to quantify it.
I hate the idea that suicidal thoughts and attempts are the benchmark that the general public uses to gauge the severity of depression.
This might not be a perfect study and it's so specialized to the individual. But even if this study shows which biomarkers from which parts of the brain are correlated with what kind of depressive symptoms, that would be leaps and bounds ahead of what current clinical psychiatry looks like.
Edit: I just remembered the extrapolating that some people are doing in the rest of the thread. The Penfield Mood Organ from the world of Philip K. Dick's, Do Android Dreams of Electric Sheep. The first chapter describes one of the characters dialing the device to make herself feel deep despair and depression for a set amount of time twice a month to feel human. It's an interesting read if people haven't yet, Blade Runner is the movie based loosely based on it. They are different enough that the book is worth reading even if you've seen the movie.
This method is entirely different than ECT. The researchers used an electrode to disrupt specific ruminative thoughts that were causing, or at least perpetuating, the patient’s depression.
It’s more analogous to traditional therapy methods applied by brute force at the physical level. Whereas traditional therapy would train patients to identify and break negative thoughts loops, this patient was apparently unable to do so. The brain implant physically disrupts part of the brain that contributes to those loops, opening the door for recovery from the self-defeating process.
The electrodes in DBS by purpose continuously release electric pulses at target locations in the brain. ECT, from my understanding is a short full brain excitation using electric pulses. The location of where the electrodes are places on the outside of the head change what part of the brain is targeted.
This research is a middle ground where they are using the same technology to send short "six second" impulses to a very targeted part of the brain.
I don't agree that this is entirely different from ECT.
https://mayfieldclinic.com/pe-dbs.htm
https://en.wikipedia.org/wiki/Trepanning
One problem with depression, as mentioned in the article, is that it's hard to define exactly what the problem is (there's no "depression center" in the brain) which means treating the symptoms is often the only option.
For starters, you could eliminate the extra-processed foods from your diet and add more natural sources of food.
Then you could follow a regiment of 2-3 meals a day. Put the protein heavy + fatty foods in the first meal of the day and the carbs heavy foods as last meals.
Make sure you are eating enough nutrients. Don't be afraid of salt.
Add lots of fermented food cause there is a link with improving the gut and its ability to fight inflammations.
Add movement and exercise, and make them a habit. Get a fitness buddy.
Make sure you are a getting regular good sleep.
I would recommend you a great podcast series called the Huberman lab, where this Stanford professor offers great insights about how the body works and what are the latest news from various research fields.
https://hubermanlab.com/
I am not aware of any good reason for worrying about when your basal metabolism is lowest. If you want to lose weight do intermittent fasting and get into ketosis.
There is a lot of promising research being done about the relationship between your gut microbiome and depression and other mental health issues.
Hopefully more research is done in populations across the world because it seems like currently most of the literature is focused on a western population.
"High-fat consumption not only leads to obesity but also causes widespread inflammation of body systems. The gut microbiome may alter the harmful effects of the high-fat diet, improving mood and behavior. By modulating gut microbiome composition through proper nutrition and probiotics, we also help decrease anxiety and depression [4]." [0]
[0] (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510518/
[4] (2018) https://www.sciencedirect.com/science/article/pii/S088915911...
I agree about the "thanks I'm cured" energy and that's why I included citations to show that it does help some people. It's worth trying. It's not the only reason for depression, but it is the easiest and has the least side effects in terms of treatment options. No constant cost of therapy and no drugs and side effects. But if you have multiple things causing issues with mental health, you're going to crave the unhealthy food to cope. That makes adherence to a healthy diet harder too.
I think the most promising recent legislation regarding food has been Oaxaca, Mexico banning sugary drinks and junk food for those under the age of 18 in 2020. [0] Which also has specific research backing that age group. [1]
There's might be some debate eventually about high-fat vs high-sugar being worse, but over-processed junk food is a good catch all I think. Neither is healthy for a gut biome although high-fat/lipid is talked about more often. [2]
I personally have a theory that high-sugar is worse than high-fat. But I have no research I can point to backing it other than the idea that low carb diets seem to do better than low fat diets. Even though diets at the end of the day it's calories in, calories out, in this context not all calories are equal. I think self measuring blood sugar levels are going to be the next big thing for diet trends.
I do agree that fresh fruits and vegetables are harder to find in places of lower socioeconomic status, but that's a more complex issue than only "elite" grocery stores reserving the fresh fruit.
GMO fruit is just as good as organic. The marketing in the west makes it seem like organic is the only way to go, but frozen fruits and non organic vegetables are just as healthy if not healthier. [3] You generally have to use harsher pesticides for organic foods anyway to get good yield. [4]
The bigger issue is that time is a also luxury and preparing a healthy meal takes time.
People who can afford that time are also affluent enough to be able to shop at elite places like Whole Foods. The supply chain for fresher fruits and vegetables means the cost is higher so it only sells at 'elite' chains where there is a demand and people can afford it.
If you're working long hours, maybe two jobs, you're not going to have time to cook, the cheapest reasonable meal is the processed fast food place.
I don't have a solution but with enough research, public policy won't be able to ignore the detrimental cost of high-sugar and high-fat and highly processed foods. One day I think we'll look at food today the way we see nicotine and cigarettes of the past, and I'm not alone in that sentiment.
[0] https://www.npr.org/2020/09/14/912029399/we-had-to-take-acti...
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284805/
[2] 2019 Microbiome and Mental Health, Specifically as It Relates to Adolescents
https://link.springer.com/article/10.1007%2Fs11920-019-1075-...
https://sci-hubtw.hkvisa.net/10.1007/s11920-019-1075-3
[3] https://extension.umn.edu/preserving-and-preparing/science-f...
[4]
Food banks are also significantly less likely to carry fresh vegetables vs canned ones.
They may use the same umbrella diagnosis, but when you seek treatment different causes of depression are all separately tested for. Food-mediated things are not top of mind, not in the least because nutrition is poorly understood and incredibly personal besides. That's something much easier investigated on your own (something you are taught the tools for when you seek therapy).
Not every therapist is the same. There's an even bigger problem when it comes to the standards of therapy.
I have strong opinions about this because I have been through the system. I prefer not to go into further detail however.
Perhaps a fecal transplant, way less invasive, would do her some good. South Park even did an episode on this topic.
Isn't this covered by "situational depression" (adjustment disorder with depressed mood) VS "clinical depression" (major depressive disorder), and the fact that diagnosis entails excluding physical conditions that cause similar symptoms?
None of the various depressive disorders (nor other psychiatric disorders) deal with defining a cause, but with describing a set of symptoms.
The point I am arguing agrees with the second thing you mentioned, psychiatry is about treating the symptoms not cause.
Should they be both treated using the same medication?
Situational depression doesn't "count" as real depression.
If the cause of the mental issues is unknown, you're left with treating the symptoms, which is certainly better than nothing, but often inexact and trial and error. Thus it makes sense to knock out any probable known causes when starting treatment before assuming an unknown cause.
My personal experience was when I was first diagnosed is that I had my vitamin levels checked, thyroid checked, had some sleep labs, and everyone recommended losing weight and exercise.
1) it is a closed loop approach, using the Neuropace device to stimulate based on local field potential recordings from sensing electrodes listening...somewhere (once I bug my librarian to pull the PDF for me I'll look more closely). The biggest effort for depression so far was the Mayberg/Emory group's constant waveform stim in the subcallosal cingulate (medtronic devices which output a set voltage/pulse duration/frequency, which have to be changed manually). W/ mixed results...
Neuropace has been out for, what, 10+ years out now, so it's not the latest/greatest tech but maybe good enough for what they are trying to do.
2) Busy year for Eddie Chang's group. They published the brain LFP -> synthetic speech paper a few months ago...
in the context of this https://www.nytimes.com/2021/09/11/health/nursing-homes-schi... it doesn't seem out of the realm of possibility
what comes after that?
I have been told the Psychiatric Care at most prisons is atrocious. The prison in my county has had a running want ad for a Psychiatrist since the 80's.
I'm referencing San Quentin.
I once heard a perp confess to a crime that would send him to prison for life with one caveat, and it was, "I just want to be sent to a prision anywhere that has a good Psychiatric Unit."
Any technology can be used for ill or good, we just have to hold people accountable.
Not sure what you would expect the device to do expect help people with depression.
The US prison system is a horrible blight, but this really has nothing to do with it.
https://www.mdcalc.com/phq-9-patient-health-questionnaire-9
https://www.mdcalc.com/quick-inventory-depressive-symptomato...