depression

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The Bionic Mind: Building Brain Implants To Fight Depression, PTSD

Liss Murphy this summer, with husband Brian, son Owen and sheepdog Ned. (Courtesy)

Liss Murphy, who had surgery to implant Deep Brain Stimulation for depression in 2006 and got much better, on Cape Cod in summer, 2014, with husband Scott, son Owen and sheepdog Ned. (Courtesy)

Ten years ago, with little warning, Liss Murphy fell victim to paralyzing depression, a “complete shutdown.”

She was 31, living in Chicago and working in public relations. The morning of Aug. 13, 2004, she had gone in to the office as usual. “It was Tuesday, and I remember the day so clearly,” she says. “The sun — everything — and I walked out — it was about 11 o’clock — and I never went back. The only time I left the house was to see my psychiatrist, who I saw three times a week.

“I have a hard time believing it was depression, in a way, because it was so pervasive and powerful,” she says. “It invaded every aspect of my life. It took so much away from me. And it happened so fast, and it was so degrading — it took everything from me.”

Murphy came home to Boston, and she tried everything — medications, talk therapy, even repeated rounds of electroshock. But she was barely able to get out of bed for months — then years. Her husband and family and top-flight doctors cared for her, but she sank so low she tried twice to commit suicide.

Finally, a psychiatrist told her about a cutting-edge trial to implant stimulation devices deep in the brains of patients with severe depression. She signed up. In June of 2006, she had the operation.

“My greatest hope that day was to have something go horribly wrong and die on the table,” she says. “I didn’t care.”

She didn’t die. Over the next few months, she got better. These days, eight years after the surgery, if you saw Liss Murphy walking her Old English Sheepdog, Ned, or playing with her 3-year-old son, Owen, only the faint silver scars on her clavicles would hint at anything unusual: That’s where the batteries that power her brain stimulator are implanted.

“We’re taking a wall of computers, basically, and putting it into something that would easily fit inside a box of Tic-Tacs.”
– Jim Moran, Draper Laboratory

But though the surgery changed Murphy’s life, “the trial, on average, didn’t work,” says Dr. Emad Eskandar, the Massachusetts General Hospital neurosurgeon who operated on her. “When you pooled everyone together it didn’t work. But there were like five people out of the 10 we did that had remarkable benefits and went into complete remission. We couldn’t continue with the study because on the average it failed, but for those people in whom it worked, boy did it work.”

Now, as part of a $70-million project funded by the military, researchers are aiming to take brain implants for psychiatric disorders to the next level.

Over the next five years, they aim to build a device that can sit inside a patient’s head, pick up the onset of depression or post-traumatic stress disorder, and head it off before it hits. One implant researcher calls it “a moonshot for the mind.” Continue reading

What Depression Stole From Me, What A Brain Implant Restored

Liss Murphy of Boston was one of the first people in the world to be successfully treated for severe depression with Deep Brain Stimulation, an electrical device implanted deep inside her brain. Now, researchers funded by the Department of Defense are trying to bring that technology to the next level, and use it to treat depression and PTSD. Here, she describes her own experience before and after the operation that changed — perhaps saved — her life.

By Liss Murphy
Guest contributor

What is depression?  After all this time, I should know. I don’t.

I know some things about depression, though. Depression is the ultimate subtractor, a thief. It erodes just about everything you are, you were, you have, you want. It takes the promise out of your existence. It destroys any semblance of hope or potential or desire or goodwill. Gone, it just is gone. It is utterly corrosive in a way that I still cannot understand.

Liss Murphy (Courtesy)

Liss Murphy (Courtesy)

Depression stripped my life of many things, of everything I knew at the time. It took away the promise of a normal day; the ability to enjoy and progress in my career and interests and relationships; the ability to think.

What follows is an attempt to make sense of the unknowns, of which there are many.  But also, what follows is a story of sickness, recovery, healing and acceptance.

What was it about August 13, 2004 that made the day what it was?

I have been told that I’d had depression before. Sure, I’d felt lousy, hopeless, tormented. But I was able to function. I could and did go on, as I needed to. It was not a roadblock.

This 2004 episode was different in every possible way. It descended on me overnight, it seems. Yes, I had been tearful and unhappy for a few weeks leading up to my crash, upset that my husband and I had separated. But so what?

It was the beginning of a complete system meltdown — a mental, physical, psychological, physiological meltdown. A total shutdown.

The details are foggy, though some of it seems so clear and vivid. It was a Tuesday, a gorgeous sunny August day. My office had a view of Lake Michigan. I walked out of the office mid-morning and never returned.  My computer was on, my running clothes, sneakers, other personal belongings in my office – waiting for me to return. But I never went back.

One important detail I cannot recall is whether I drove to work or took the subway.  I think I drove but … I am hung up on those details now. Because that day I did not just have a mental meltdown; it was the beginning of a complete system meltdown — a mental, physical, psychological, physiological meltdown. A total shutdown.

I can still see each room in my Chicago apartment as it was back then, as confused as I was. Each day, the rooms got more confusing, more messy, until it all blended into a universal squalor. I see images of brown rice boxes on the kitchen counter, dull steak knives, the tips of burning cigarettes against the hue of a bluish-purple sky just before nightfall. I slept on the couch. I stopped running, started smoking. After that day in August, I only left to see my psychiatrist, three or four times a week, until I came home to Boston.

It wasn’t feeling sad. It was feeling nothing. It was a total void of feeling. For two years, I was basically mute — totally withdrawn from everything. Continue reading

Opinion: Time To Lift The Black Box Warning On Antidepressants

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

By Drs. Steve Schlozman and Gene Beresin
Guest contributors

In 2004, the Food and Drug Administration made the difficult decision to apply a “black box” warning to virtually all antidepressant medications.

A few months earlier, British health officials had issued a similar warning for paroxetine, or Paxil, a frequently used antidepressant. Both the United States and the United Kingdom were worried about the possibility of antidepressant use in some people causing an increase in agitated, and even suicidal, behavior. The warnings, still in effect, apply particularly to adolescents.

But recent research suggests that perhaps the black box warning should itself have a black box warning. A new Harvard study suggests the warning has actually led to an increase in suicides because it caused a decrease in the treatment of depression through antidepressant prescriptions. Similar studies published back in 2007 showed a fairly dramatic increase in suicide attempts by adolescents, corresponding to a decrease in prescriptions for antidepressants. The Harvard study is a reiteration of these previous findings.

We believe it is time for the black box warning to be lifted. And we suspect that bias and ignorance may play a role in the fact that it has not been.

First, some background information.

A “black box warning” is a written message that by U.S. law must accompany every prescription for which the warning is indicated. Continue reading

Meditation ‘Overrated’? Not So Fast.

(RelaxingMusic/Flickr via Compfight)

(RelaxingMusic/Flickr via Compfight)

My doctor recently suggested I stop multi-tasking. Focus on one thing at a time, she said: our brains aren’t wired to take on the kind of intense juggling — from chauffeuring to food prep, extracurricular logistics, work strategies, worry over aging parents, anxiety about climate change — that many of us attempt (with varying degrees of success) every day.

For me, meditation and yoga offer a lifeline: a quiet sanctuary where focusing on one thing is the only thing required.

So I was slightly annoyed by the headline of a recent Scientific American story: “Is Meditation Overrated?”

The premise of the piece is this: Many people report that meditation improves their mood and relieves various symptoms of chronic stress and other health problems, BUT the data on this isn’t terribly robust. So, the story continues, “Johns Hopkins University researchers carefully reviewed published clinical trials and found that although meditation seems to provide modest relief for anxiety, depression and pain, more high-quality work is needed before the effect of meditation on other ailments can be judged.”

So shouldn’t the headline be: “Meditation Relieves Some Modern Woes; More Research Needed To Conclusively Prove Further Benefits?”

Or, my own personal headline: “Meditation Helps Me Scream At My Kids Less And Not Attack My Husband When There’s Yet Another Wet Towel On The Bed.” (See also, a new study, entitled: “I Am A Nice Person When I Do Yoga!!!)Continue reading

Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading

Study: Meditation Relieves Some Anxiety, Depression Beyond Placebo

papermoons/flickr

papermoons/flickr

We’ve all been there: feeling low, overwhelmed, anxious, or just majorly bummed out about the freezing cold, the dead-end job, the noncompliant spouse, whatever, and we dream of a pill — a quick fix — to put an end to all that negative muck.

Of course, pills have side effects, and don’t always work. But it turns out there’s something that may be more effective with no downside, though it takes a bit of effort: meditation for about 30 minutes a day.

A new analysis by researchers at Johns Hopkins find that just a half-hour of “mindfulness meditation” may improve some of these garden variety, not yet full-blown, symptoms of anxiety and depression. The findings, published online in JAMA Internal Medicine, also found that some pain symptoms can also be relieved through a consistent meditation practice.

This should not come as breaking news. Many studies over many years link meditation to all kinds of health improvements. But I think it’s worth restating, since meditation is still viewed as a crunchy, ineffective practice by so many — including those in the medical mainstream.

Here’s lead study author Dr. Madhav Goyal, assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, quoted in the news release:

“A lot of people use meditation, but it’s not a practice considered part of mainstream medical therapy for anything,” says Goyal, M.D. M.P.H. “But in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants.” Continue reading

Family Meal Boost: Lower Depression, Eating Disorder Risk In Girls

The concept of “the family meal” remains elusive — more nostalgia than reality — for many modern families. But it’s still worth striving for, according to a recent analysis by public health researchers at Tufts, who found that frequent family meals can reduce the likelihood that teenagers, particularly girls, will develop problems ranging from alcohol and tobacco use to eating disorders and depression.

sunface13/flickr

sunface13/flickr

Despite the benefits, researchers report that less than 60 percent of children eat five or more meals with their parents each week.

I asked the lead researcher, Margie Skeer, an assistant professor of public health and community medicine at Tufts University School of Medicine, a little about her analysis, published in the Journal of Youth and Adolescence. Here, lightly edited, is what she said:

RZ: What happens at family meals that may be protective against risky behavior, like substance abuse, or other mental health problems?

MS: If family meals are frequent and consistent, mealtime can serve as a conduit for open, ongoing communication, where people come together to not only eat, but to talk about their day. In this regard, mealtimes can provide for a baseline level of communication, whereby parents/guardians can learn about the everyday, ongoing aspects of their children’s lives — both important and ordinary. This can create an environment that allows for the development of three crucial features of the parent-child relationship. Continue reading

Tumblr Blocks Some Mental Health Topics, Thwarts Therapy

LibbiAs a member of the Millennial Generation, Libbi Gildea, 20, discovered a new coping mechanism for dealing with an age-old mental health issue – social media.

But just as she started to heal from a personal trauma, she found that a tech giant was starting to dismantle her new, safe space.

In December 2012, Libbi was raped on the campus of a prestigious school in Massachusetts. She was 19 at the time, a college sophomore. After the attack, she developed PTSD and depression and took time off school, trying to heal. She spent time recovering in the hospital, and traditional talk therapy helped. But, she says, she found the most comfort in a more contemporary setting. Libbi joined the microblogging site Tumblr and started browsing posts tagged with topics she was interested in, like depression and PTSD, meeting others that were going through similar experiences. In an interview, she gave me permission to use her name, and explained how she evolved from feeling totally alone after the assault, to much more connected and supported through social media:

I felt really isolated because I didn’t know anyone else that had PTSD. You don’t realize that what you’re experiencing is normal … After I was done with the hospital and I didn’t have group therapy anymore, a friend mentioned that there was a pretty vibrant mental health community on Tumblr.

So I made a blog there. I started randomly one day, posting that I wished I could make a mental health “resume” so I wouldn’t have to go through my experience every time I saw a new doctor. I did another post of more of a personal nature on the night of my birthday because I was angry and feeling that my attacker had taken a lot away from me. I wrote him an open letter that said, “You may have raped me, you may have taken this from me, but I’m still here, and my life is only going to get better, and frankly, I feel sorry for you.” Continue reading

Study: Your Brain Makes Hundreds Of New Neurons A Day

(Digital Shotgun/flickr)

(Digital Shotgun/flickr)


This just in from the journal Cell: Your hippocampus, a key region for memory in your brain, makes a few hundred new neurons every day.

Does this mean you can now drink Tequila shots with impunity because you can more than make up for the brain cells you damage? Nope, no reason to think so. But the findings in Cell could have implications for future research in areas from antidepressants to Alzheimer’s disease.

Mainly, the new study helps cement the long-controversial claim that new neurons keep a-borning in the human brain all through life. And it does so in a creative new way, using carbon-14 left in humans by above-ground nuclear tests in the mid-20th century to measure the ages of brain cells.

I asked Prof. Joshua Sanes, director of Harvard University’s Center for Brain Science, to explain what the study could mean — why it matters whether our hippocampi keep making new neurons or not. His reply, lightly edited:

The basic dogma of neurobiology has been that you’re born with all the neurons you’re ever going to get, and then everything goes downhill from there.

But there was heated debate about this, and eventually, it was found in experimental animals that you do actually get new neurons throughout life — but weirdly, only in a few places. Where would depend on the species, but for mammals like us, it’s your olfactory bulb — what the heck that is about, nobody has any idea — and the other place is the hippocampus.

The hippocampus has proven to be critical to memory, and I’m not sure whether you’d say memories are stored there, but they certainly seem to be made there. You probably know about the famous patient HM: When he lost his hippocampus, he lost his ability to make memories.

So the idea arose that maybe if you’re making new neurons in the hippocampus, that’s to help you make new memories. In mice, there’s some evidence that favors that idea. I think nobody thinks it’s going to be as simple as that — that every time you need a new memory, you make a new neuron — but there are lots of experiments where they prevent the making of new neurons and somehow degrade memory in mice. And it seems that a lot of the things that a mouse does can affect how many new neurons are made, or at least how many of the new neurons that are made wire up.

One of those things is exercise: if you exercise more, you make, or keep, more new neurons. If you suffer a lot of stress, you make fewer neurons. Depression has been implicated; nobody knows how but there’s some idea that antidepressants can help you make new neurons, and if you’re depressed, you make fewer neurons.

So people have been interested in these new neurons, but nobody knew whether they were made in the human hippocampus, and this new study tells you that they are. Continue reading

Swartz On Depression: ‘Unable To Feel The Joy’

I can’t stop thinking about what, exactly, drove 26-year-old Aaron Swartz, the technology whiz kid and free-information crusader facing federal charges for wire and computer fraud, to hang himself last Friday. What was the final straw that broke this brilliant, so-very-promising young man?

His family clearly believed it was government persecution. In a statement they said his suicide “is the product of a criminal justice system rife with intimidation and prosecutorial overreach. Decisions made by officials in the Massachusetts U.S. Attorney’s office and at MIT contributed to his death. The U.S. Attorney’s office pursued an exceptionally harsh array of charges, carrying potentially over 30 years in prison, to punish an alleged crime that had no victims. Meanwhile, unlike JSTOR, MIT refused to stand up for Aaron and its own community’s most cherished principles.”

But Swartz’ own writings suggest that he suffered from depression, which could have been a factor as well.  In 2007 he offered this portrait of his distraught state of mind; the deadened outlook and sense of being trapped in a downward spiral:

Depressed mood: Surely there have been times when you’ve been sad. Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it’s worth going on. Everything you think about seems bleak — the things you’ve done, the things you hope to do, the people around you. You want to lie in bed and keep the lights off. Depressed mood is like that, only it doesn’t come for any reason and it doesn’t go for any either. Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness. Continue reading