Changing Minds: Area 25

Experimental Brain Surgery May Help The Severely Depressed

(CBS)  Eighteen million Americans suffer from major depression. Most of them are treated successfully with a combination of “talk therapy” and anti-depressant drugs. But millions of Americans – possibly as many as four million - are afflicted with what is known as “treatment-resistant” depression. For them, nothing works, not even electric shock treatments. They endure lives of debilitating sadness and some end up committing suicide.

But as correspondent Lesley Stahl reports, early results from an experiment in Canada have raised hopes for an answer to their suffering. It involves surgery on a region of our brains called Area 25. And, for the small group of patients who have signed up, the risks seem worth taking, because this is their last resort.

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"It's kind of, for me, just a feeling of sadness, hopelessness, overwhelming," says 49-year-old Debra Prupas of Toronto. She was diagnosed with depression 15 years ago. It would seem that Debra had little to be depressed about, with a career as a high-level lawyer, a new husband, Bern Grush, and two daughters adopted from China.

"I call myself the great imposter," Prupas says. "I could fake my way through it. People - nobody knew. And then in the past few years, I've not been able to do that. I can't even get out of bed."

Debra has tried everything: numerous psychiatrists, anti-depressants: more than 30 different kinds, and a dozen electric shock treatments. Nothing worked.

Spending up to 18 hours a day in bed, Debra had to abandon her job, stop seeing friends and had thoughts of suicide. That left Bern taking care of her and the children.

"I'm just absent. I don't want to go out with my husband. I don't want to talk to – I withdraw," she says. She even withdraws from her daughters.

Coincidentally, at nearby Toronto Western Hospital, researchers had started a pilot study on a new treatment for people like Debra.

Studying the brain scans of severely-depressed patients, Dr. Helen Mayberg, the study’s lead neurologist, kept seeing that a small almond-shaped node was in over-drive.

"The area of the brain that was the most active was Area 25," Dr. Mayberg explains.

Area 25 – deep in the very center of our brains – is connected to other areas that control sleep, appetite and drive, all the things that go haywire when someone’s depressed. Mayberg’s theory is if you cool off area 25, you treat the disease.

She decided to try a technique called deep brain stimulation, that involves threading two thin electrodes through the brain, directly into Area 25 and stimulating it with continuous pulses of electricity from a pacemaker in order to jolt it back to normal.

Mayberg’s research partner, neurosurgeon Andreas Lozano, says it’s a far more targeted treatment than anti-depressants.

"The difference is, with antidepressants, that the 100 billion neurons in your brain get the drug. And here we estimate that we're affecting only a few hundred thousand neurons. And so, this is a surgical strike," he explains.

And like any brain surgery, there are risks, like stroke or infection.

[OhWi]

Hi,my name is Bill and i have been afflicted with depression for most of my adult life.(I am a 40 year old male) It seems to affect everything i try,jobs,relationships ect.I have tried a dozen or so meds,talk therapy,CBT ect.Nothing works.I have a few years left,but i'm not going to make it if i don't find a way to turn the tide on this depression.I like DBS because it is targeted and permanent.Please,if anyone can direct me to a trial or a doctor that can help facilitate this procedure,it would be greatly appreciated.I am a veteran and get my care through the Vets hospital.If i have to pay for it i would be willing to pay(Beg,borrow or steal) to get the money.I am quite desparate at this point.So damm tired and want just a little relief.If you can help me please forward the realevant information to: [e-mail] Thanks for listening.

[by_annie]

Hello,

I am a Mongolian women. I am suffering from depression for 3 years. By chance i found out about DBS. I would like to know whether the surgery available for me or not.........please email me or post a link

[redyankee47]

Hello,
I've been treated for major depression for over 20 years, I would be very interested in participating in the clinical trials for deep brain stimulation here in the US. Do you have any contacts for this program? If so , please email them to me, or post a link.
hopeful in Louisiana

[kmk1964]

I was diagnosed with depression approx., 20 yrs. ago and have been on numerious anti-depressants and anti-depressant combinations and have had numerous ECT treatments. Do you have any information on the study for the deep brain stimulation area 25 that will be going on in the United States - I am very interested in being in this study.

[spacestevie]

While this technique maybe well and good, we all know that the potential exists for abuse. As with all good things, there are those who would use this proceedure for recreational purposes. If legal, the clinics might be like those which perform plastic surgury today. If illegal, the back alley clinics would probably do the service. Either way, we have people today who would pay anything for a permanant high. There were people in the 60's who drilled holes in their heads chasing a permanent high. This seems the high tech version.

[rmmerritt]

My name is Rhonda I have a 21 year old daughter who has been suffering from depression and other sychological disorders since she was 15 years old. Please help me find out how I can get her in the study for this new treatment area 25.
Thank you

[chuck_the_czech]

Will insurance pay for this procedure? Can anyone point me in the right direction?

[answers6]

I have been bothered with muscle pains, joint pains, skin lesions, and depression for several years. One week ago I started my own treatment. Stay with me I started a Fungal treatment taken orally and in one week the pain is gone, skin problems clearing up, brain fog and depression gone and as a side effect I have lost 11 pounds. Please from a 57 yr old nurse keep searching because there is help out there and it is not always where you think!!!!!!!!!!

[jreizes]

Newer treatments for depression are exciting developments and I believe brain science is the path to the future for those who suffer from this debiliatating and still misunderstood disease. Right now the best approach we have to making sure that depression does not become chronic and an unremitting way of life is early diagnosis and intervention. I work for a nonprofit organization that runs National Depression Screening Day which happens to be October 5th, this Thursday. If you or anyone you know is concerned about depression or a related disorder visit www.MentalHealthScreening.org to find a local nearby site. This public service project is completely free. Early detection, like with many other illnesses, is key.

[tsunami3025]

This sounds great, I have also suffered with bouts of depression over the past 15 years and I have tried so many different kinds of meds that didn't help. It would be great for this to become another type of treatment that is available for people who are taking meds that don't really help. I would love to be a participant in your study!!

[will61je]

I've been suffering from clinical depression for 30 years now. For many, unmedicated, and for some treated. I've managed to survive but I've never really lived. I've used my children as an excuse, but truth is, I've needed them probably more than they have needed me. I've lost jobs, lost homes, lost friends, lost self-dignity and have tried relocating several times. Nothing has worked and I believe the only reason I haven't yet committed suicide is that I'm to much of a coward. I've prayed for the lord to take me of natural causes and of course that hasn't seemed to work either. I would give anything to be a part of this experimental treatment. I have nothing left to lose. I've already lost it all. I was released today from mental health at Aurora. I promised today not to kill myself. I've been put back on prozac. It will eventually elevate me to a place where I'm not always crying but I won't be singing,laughing, or dancing like I once used to. Of course that was when I was drinking that I'd do that, and I haven't drank in years now. Now I just go numb. When my dreams are more exciting, more romantic and more adventerous than my life, there is definately something wrong. If anyone can help in anyway, I want to be a part of Area 25 research before it is to late for me. Thank you.

[e-mail]
920-946-5338

[marsha3433]

Hello,
I've been treated for major depression for over 20 years, I would be very interested in participating in the clinical trials for deep brain stimulation here in the US. Do you have any contacts for this program? If so , please email them to me, or post a link.
hopeful in Texas

[vipaka]

Wonder if this new treatment works on post traumatic stress flashbacks? Or does anything else work?

[blenheims4]

I don't remember feeling hopeless as a child. We travelled to artists' colonies in Europe, and the
inate eccentricites of my parents 'friends probably masked many things. At 16, during my first year at GU, I attempted suicide' and was treated by Kalinowski with EST. I did graduate, but from then, by turns, I was in the hospital or somewhat active outside. Sleep, family suicides,pills...treatment resistant depression... thus, I now go on. I would really like
to try the DBS, as it is very difficult to endure this sadness. I did go for a VNS interview,but was rejected because I cycle to rapidly.
I would like to thank 60 minutes and Leslie Stahl
for presenting such a sensitive and well written
report.The subsequent comments only begin to reflect the enormity of this problem.

[robmeg11]

PART 3 OF 3
I ended up with an unplanned pregnancy which halted the process of having VNS surgery. Now that I have 5 more months to consider VNS, I am really scared about the side effects. That is why I was so excited to see the 60 minutes report on DBS & area 25, as it seems like it has the same goal as VNS but skips the step that causes the side effects and goes right to the source of the problem. I think I will wait for future discoveries in the treatment of depression. Unless, of course, my depression returns fully after my baby is born. Suicide doesn't sound good to me as a solution. Please DO YOUR OWN RESEARCH on all the treatments available. There is a lot of new stuff out there, and more coming.
Take Care All!

[robmeg11]

PART 2 OF 3
Also, VNS can cause some pretty severe side effects. The side effects are not all listed in the official literature because there have been so few controlled studies. I learned of the unpublished side effects from a phone conference sponsored by the manufacturer of the VNS device. There were real patients %u201Cunscripted%u201D at the end of the call. One had SEVERE pain (uncontrolled), many had trouble swallowing or constant cough or their voice was permanently at a whisper volume, etc... I was going to get the VNS surgery done anyway. There were so few doctors that will even touch this treatment with a ten-foot-pole (I am talking about doctors in the military who gain nothing by doing or not doing this procedure). Most said they wouldn't do the surgery because of the low success rate and that they were concerned that their patients would be so disappointed that they would commit suicide, and that the only surgeries they do are on those who are pretentious about the success VNS offers. I told them that the 2% chance was worth the risk.

[robmeg11]

PART 1 OF 3
I am sorry I don't have the time to respond to this with the forethought and time it deserves. I have treatment resistant depression, anxiety disorder, & panic attacks. I%u2019ve been on at least 16 different meds (multiple times & combinations), I have had 12 ECT treatments that kind of helped, but gave me so much anx&panic that I actually became depressed again. I was desperate and certainly suicidal (prior to and after) ECT. I looked long and hard into Vagus Nerve Stimulation (VNS). It sounded great, at first. I slowly became aware of its LOW success rate (33% partial recovery after 1 year & 2-3% chance of full recovery).

[rsaab]

I am quite interested in your story on the Transcranial magnetic stimulation. I am writing from Johns Hopkins Hospital where I'm a patient being treated for depression and bipolar disorder. In the beginning of my stay here September 5 - 20, I was exposed to 6 ECT treatments which hekped my mood but sent me into a slight mania. I am still here trying different cmedicines and combinations.

Watching your story got me and most of the other inpatients really excited. Some were talking about hospitals in the U.S. that were already conducting the surgery...that part I couldn't find in your story on the web. Do you have that information? I am definitely interested in performing this surgery as I am sick and tired of feeling like someone hit me on the head and experiencing life as if I have glue on the soles of my shoes slowing me down in everyhing I try to do.

Waiting for your response

Rabab
301-535-0757
6729 Mink Court - Waldorf, MD 20603

Note: Can I get a ttranscript or a video of the story?

[october1929]

Dear Ms. Stahl,

You did a terrific report about a very complicated subject and surgical procedure. You asked good scientific, business and human questions.

Viewers should be aware that there is a new FDA approved neurostimulation procedure for severe or chronic depression called vagus nerve stimulation. The ninety-minute out-patient procedure is not related to brain surgery or shock treatments. It has been proven to be highly effective in patients with the most treatment-resistant form of depression.

Depression sufferers should be asking their psychiatrists about vagus nerve stimulation, which is readily available in the United States.

[myradale]

Hello:
I am a 67 year old Jewish, female nana, originally from The Bronx.
My resistent to treatment depression has influenced the quality of my life since college, when I experienced my first episode.
For the next 40 years, I used the following approach to the condition:
1. the primary attack was psychotherapy, even 4 years of psychoanalysis. Coming from a highly dysfunctional family - filled with depression, neuroses, schizophrenia, suicide and physical violence - I was sure I could overcome my situation thru reliving the endless triggers that were my growing up life story.
I finally, reluctantly ended talk therapy when I had to call my psychiatrist from Princeton House to cancel my next appt.
2. The secondary attack was thru medicine. My husband,was a research scientist at J&J, was deeply commited to this modality of treatment. I tried every pill on the market, many times over time. No difference.
3. Today 's mode of treatment? ECT maintenance therapy at Uof Penn. in combination with a healing lifestyle that includes
4. Yoga, Meditation, Exercise and Sports, respectible eating habits, and moderation.
I'm glad you see fit to include new advances in the treatment of Depression as a worthy topic for 60 Minutes. We still have such a long way to go in treatment and even the identification of symptoms associated with Depression.
Keep up the good work!