Much Madness about Depression

Before I wrote my Times Magazine story on treating depression with deep-brain stimulation implants, several people (including myself) warned me I'd hear complaints about promoting psychosurgery. Those warnings proved fair, Letters to the Times and myself, as well as blogs, opined that the story was "trumpeting psychiatry's latest 'cure' for depression" (The Alliance for Human Research Protection); that the Times was "hyping yet another reckless and scientifically baseless approach for treating depression"; and that we should be doing more talk therapy (agreed) instead of surgery (not necessarily agreed; the latter doesn't rule out the former).

One letter writer, apparently thinking he'd caught me out, noted that a Times story by Benedict cary last October, "Can Brain Scans See Depression," reported that

"After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies."

These complaints assume that I'm hailing this experimental surgery as a cure to recommend — despite that the entire story, beginning with the first sentence, makes clear that the procedure is experimental, its results provisional, and its promise as a direct therapy limited, at best, to a few thousand severely ill patients:

[No] one sees this becoming the new Prozac. The procedure costs too much (around $40,000) to use on anyone who hasn't tried everything else. The appropriate candidates for D.B.S. probably number in the thousands, not the millions. Perhaps the most sensible worry is that if the thing works, doctors might use it too freely, as they tend to do with successful new treatments; witness the problematic boom in D.B.S. for Parkinson's.

In the end, the procedure's greatest clinical value may lie in inspiring less intrusive ways of tweaking key nodes — localized delivery of drug or gene therapies, or other means still to come. Such possibilities probably lie at least a decade away.

Now that seems pretty plain. That it gets read as a trumpet call for depression's latest wacky cure speaks to how strongly people feel about the patchy history of psychiatry. What with Freud's more bone-headed theories, hack work like lobotomies, and the current excesses of the drug companies, there's plenty of reason for skepticism and anger. To treat shoddily the mentally distressed is malpractice particularly foul. But this DBS trial is being done carefully, using a reversible intervention proven effective and safe in tens of thousands of Parkinson's patients. (That the objections have to do with mental health treatment rather than tweaking the brain is suggested by the utter lack of outcry about the tens of thousands of Parkinson's patients. No one hollers about wiring them up.) No neurons are destroyed, and the voltage is low and affects an area about the size of a pea.

To paint this as kin to lobotomies and early, punitive shock therapy misses the mark.

The story did get some more thoughtful looks. The Neurocritic offers some interesting observations, and Liz Spikol's fascinating blog "The Trouble with Spikol" took notice, and Searchblog posts a lively personal reaction titled "I Am Not a Toaster.. And -- my favorite -- a concert pianist didn't like my orchestra metaphor.