The Following article is from the Daily Mail, anything that alleviates this disabling condition is to be welcomed and certainly more research needs to be done. In away this procedure harks back to the old "Electric Shock" treatment that used to be used for certain types of Depression. That procedure tended to have a hit or miss effect however there were severe side effects of memory loss. As the brain is more understood it will only be a matter of time to understanding (what is essentially a physical ailment) Depression and and all mental and emotional conditions and rid these conditions of the terrible stigma associated with these illnesses.
Brain surgery saved my husband from the torment of depression
When the celebrated theatre critic Sheridan Morley plunged into suicidal depression, his wife Ruth Leon was told his only hope was pioneering brain surgery.
In this moving account, she describes how her husband became the first patient in Britain to undergo the treatment...
Devoted: Ruth Leon and husband Sheridan Morley. He had suffered from depression for 20 years before having a stroke in November 2002
I felt equally frightened now the moment had arrived, but tried desperately to look and sound positive.
When the operation had first been mooted, I was stunned.
‘Brain surgery?’ I gasped. ‘What would that do?’
Professor Guy Goodwin explained to us, for the first time but certainly not the last, the procedure called deep brain stimulation (DBS).
This involved the implantation of a device that attempts to regulate the activity of certain parts of the brain, just as a pacemaker regulates the heartbeat.
He explained that though this was being used widely for the alleviation of the more distressing symptoms of Parkinson’s disease, it was only being tried out as a possible treatment for the alleviation of otherwise intractable depression — the kind that Sheridan, like half a million other Britons, had.
The kind that doesn’t respond to medication.
Sheridan had suffered from depression for 20 years before having a stroke in November 2002. After this, his depressive illness became acute.
He was home from the hospital for only a day when it became clear he had descended into the worst depression of his life. His eyes were clouded, he wouldn’t get out of bed, he cried non-stop. He was almost entirely silent.
After his stroke, Sheridan's depressive illness became acute
I couldn’t bear seeing him so unhappy, but for three years I’d been on duty 24 hours a day, seven days a week, and I had no choice but to watch him deteriorate into a person I didn’t know.
This man I had loved and laughed with, this wonderful man I had worked and played with, this amazing man who had changed and enriched my life, was a stranger.
I’d been told that Professor Goodwin at Oxford’s Radcliffe Infirmary was ‘the best man in the world for treatment-resistant depression’.
And finally I’d managed to get us in to see him. Professor Goodwin’s hope was that with DBS the doctors could adjust Sheridan’s moods after the operation with the use of an electronic remote control.
Though a pioneering Canadian neuroscientist, Dr Helen Mayberg, had performed seven of these operations, the technique had never before been used in this country or, indeed, anywhere in Europe for depression. No one knew whether it worked.
Her results had been mixed — one patient had had no reaction at all, four were somewhat better, two were much better — and, of course, no one knew whether Sheridan was a good candidate for the operation or even whether there was a chance it might work for him.
He was still sitting with his head down, taking no part in the conversation. We tried to discuss it with him. All he could say was that if it would make him better he was in favour of it.
The problem with that endorsement was that by this point Sheridan was so depressed that if you had told him we had a solution, but that it involved chopping off his head, he would have headed for the nearest axe.
Professor Goodwin said it was up to us, which, in effect, meant it was up to me, as Sheridan was way past the stage where he could make a rational decision about lunch, never mind whether he would allow someone to operate on his brain.
‘What are the risks?’ I asked. ‘Could he be reduced to a vegetable? What’s the worst that can happen?’
The worst, said Professor Goodwin, was nothing. It was possible he’d have the operation and it wouldn’t work.
It might work partially. That is, he might feel somewhat better, but not much.
Or it might be a spectacular success, drive back the negative feelings and regenerate some of the nerve endings or pathways that had been destroyed by the stroke.
He might then be restored to something like his pre-stroke self. No one knew and no one could tell. But, he concluded, he won’t feel worse than he does now.
Sheridan lifted his head for the first time.
‘Not possible,’ he said. ‘I couldn’t feel worse than I do now.’
The procedure called deep brain stimulation (DBS) had never been used anywhere in Europe for depression
I was afraid that Sheridan was feeling so ill that he would find the energy from somewhere to take his own life.
On the day of the operation — Wednesday, October 19, 2005 — the operating theatre was full of people, 17 at the only time I tried to count them, and they were all busy.
The atmosphere was full of wonder. Every person in the operating theatre, except possibly Sheridan, was alive to the extraordinary event they were witnessing.
Before the operation started, Sheridan was asked a long list of questions
‘Tell us, on a scale of one to five, one being not at all and five being extremely, how angry, scared, relaxed do you feel . . . ’ and so it went.
Then Professor Goodwin asked how he felt.
‘Suicidal,’ came the predictable response. ‘There’s no future. I know Ruth is going to leave me, all my editors will fire me, I’ve got no pension and no money, my children hate me, I’ve made such a mess of everything.’ No change there, then.
Sheridan had been given enough sedation to keep him calm, but still leave him awake so he could answer Professor Goodwin’s questions about his state of mind.
He also needed anaesthetic in his scalp so he wouldn’t feel the surgeon drilling holes as large as 5p pieces on both sides of his forehead. These were for the electric probes that would be inserted into his brain.
Working quietly, Professor Tipu Aziz, who was performing the operation, and his surgical assistants made their incisions, peeled back the flaps of skin and adjusted a scary-looking hand drill with a crank handle.
‘This won’t hurt,’ Carol the nurse said to Sheridan, who was beyond caring.
‘But it is noisy. So, don’t worry.’ Actually, it wasn’t even as loud as a dentist’s drill.
Because my job was to be the face that Sheridan recognised when he opened his eyes, I was allowed to be in the theatre without a mask. In truth, he rarely opened his eyes, but did respond when I spoke to him. He knew, at least intermittently, that I was there.
Suddenly, Tipu inserted a long electric probe like a meat skewer into one of the two holes he’d drilled into Sheridan’s head. He asked Sheridan to tell him what he was feeling.
Cautiously, not wanting to overstate, Sheridan said, quietly and haltingly, but in his normal voice rather than the awful whine that had replaced it for nearly three years: ‘Well, I don’t feel suicidal any more.’
Then he corrected himself: ‘The suicidal despair has lessened. It’s still there, but it’s less.’
Tipu indicated to his electronics team to raise the current level. ‘And now?’
‘Now I can see some rays of hope. I think maybe the future isn’t so bad. Maybe there’s a future after all.’
It was the best moment of my life. Professor Goodwin looked at me over his mask and I could feel the warmth of his grin from across the room, even though I could only see his eyes. It was working.
‘Let’s do the other side,’ said Tipu, and he inserted a probe into the hole drilled in the other side of Sheridan’s head.
The right side wasn’t quite as dramatic. Sheridan reported that his mood was lighter, but not very. I was jubilant.
Tipu explained later this was because Sheridan’s stroke had occurred on the right side and less could therefore be expected immediately. But this was where they were hoping the brain stimulation would encourage the regeneration of brain cells destroyed by the stroke.
COULD BRAIN OP ALSO BEAT OBESITY AND DEMENTIA?
Sheridan Morley's brain ‘pacemaker’ implant was a pioneering operation which today, six years on, is still ahead of its time.
British experts are working hard to turn the electronic technology into a fully work-able treatment.
The DBS technique involves implanting millimetre-thick electrodes deep into a patient’s brain. These are connected to a pacemaker that sends electronic pulses into specific areas to inhibit or stimulate that part of the brain.
The treatment is increasingly being used for Parkinson’s disease, where it can prevent tremors. It’s also being tested for chronic pain, Alzheimer’s and even obesity.
Professor Guy Goodwin, of Oxford’s Radcliffe Infirmary, who treated Morley, had read trial results from experiments in Toronto on depression patients.
‘I decided the promising data justified a one-off attempt in Sheridan,’ he says.
But he doesn’t consider it to have been a total clinical success.
‘It did not work very well,’ he says. ‘In part, I suspect this is because the effects of the stroke continued to disrupt his brain.’
Nevertheless, British experts are continuing to develop deep brain stimulation in the hope it might treat the estimated 500,000 Britons whose severe depression does not respond to conventional drugs.
Medics at Frenchay Hospital in Bristol will be publishing the results of a clinical trial on the technique later in the year.
‘There are mixed results, with some patients showing promising results and some a degree of improvement. But others have not improved at all,’ says team leader Dr Andrea Malizia.
DBS is being tried on other psychiatric problems, including obsessive compulsive disorder. U.S. researchers have reported that some of their worst-affected patients had managed to keep their symptoms under control for more than eight years with the treatment.
U.S. neurosurgeons are also using it on obesity, targeting the area that controls our desire to eat and making patients feel full.
Early indications are ‘promising’, with some eating less and losing weight.
JOHN NAISH
British experts are working hard to turn the electronic technology into a fully work-able treatment.
The DBS technique involves implanting millimetre-thick electrodes deep into a patient’s brain. These are connected to a pacemaker that sends electronic pulses into specific areas to inhibit or stimulate that part of the brain.
The treatment is increasingly being used for Parkinson’s disease, where it can prevent tremors. It’s also being tested for chronic pain, Alzheimer’s and even obesity.
Professor Guy Goodwin, of Oxford’s Radcliffe Infirmary, who treated Morley, had read trial results from experiments in Toronto on depression patients.
‘I decided the promising data justified a one-off attempt in Sheridan,’ he says.
But he doesn’t consider it to have been a total clinical success.
‘It did not work very well,’ he says. ‘In part, I suspect this is because the effects of the stroke continued to disrupt his brain.’
Nevertheless, British experts are continuing to develop deep brain stimulation in the hope it might treat the estimated 500,000 Britons whose severe depression does not respond to conventional drugs.
Medics at Frenchay Hospital in Bristol will be publishing the results of a clinical trial on the technique later in the year.
‘There are mixed results, with some patients showing promising results and some a degree of improvement. But others have not improved at all,’ says team leader Dr Andrea Malizia.
DBS is being tried on other psychiatric problems, including obsessive compulsive disorder. U.S. researchers have reported that some of their worst-affected patients had managed to keep their symptoms under control for more than eight years with the treatment.
U.S. neurosurgeons are also using it on obesity, targeting the area that controls our desire to eat and making patients feel full.
Early indications are ‘promising’, with some eating less and losing weight.
JOHN NAISH
But we agreed that whatever made him feel better was worth having, placebo or not. In the event, when they tried fooling him by turning the current down or off, Sheridan was clearly not having any.
‘It’s gone again,’ he said. ‘I feel just as bad as I did before.’
No placebo effect, then. The improvement he had experienced was due to the treatment, and it worked.
As soon as the probing was over, they were ready to put him under so they could implant a permanent stimulator device into his chest to power the electrical pulses. There was a brief conference in a side room with Professor Goodwin and his staff about whether or not to turn on the stimulator.
I argued for it, hoping that when Sheridan woke up the astounding improvement we had just seen in the operating theatre would have returned. The medical staff said that the trauma of the operation would be such that it would block any effect from the device.
This was the first time I heard that, in the case of Parkinson’s and pain management stimulators, they often don’t turn on the machines for six weeks to allow the swelling to go down.
After an operation, there is swelling around the incisions and until the body returns to normal — and in the head it takes longer than in the body — the current can’t be regulated properly.
I was expecting an immediate improvement, however slight, and then a slow adjustment over the following weeks and months. I wish they’d warned me. But there was nothing to do but wait.
Sooner or later the swelling would go down and the stimulator would kick in. Only then would we know the extent to which it might work to improve Sheridan’s mood.
Meanwhile, Sheridan was awful to everyone, not just me, whining and complaining.
‘It didn’t work... You made me have this operation and now I’ve got cross-stitches all over my face... Make them take it out... I’ve got a black eye... I’m hungry... I’m not hungry, take it away... I hate this house... I want to die... I want to move back to the country... I hate walking... I’m sicker now than I was before the operation... It’s never going to get better and you put me through all this for nothing.’ And on and on.
It was August 28, 2006, a Sunday morning. I’d come home from playing tennis with friends and as I walked up the stairs something seemed different. Not wrong or bad, just different.
Sitting at the dining table in the conservatory was Sheridan. He had a mug of coffee and was reading the Sunday papers. He looked up, smiled at me and inquired casually: ‘Had a good game, darling?’
It was as though the whole of the preceding four years had never happened. He was entirely himself, entirely present in the moment. His eyes were clear, he looked straight at me, his voice — that wonderful, beloved voice that I had missed so much — was there again.
He seemed unaware of the change in him, as though he were Rip Van Winkle waking up from his 100-year sleep, oblivious to the fact that yesterday he had been a sleeping zombie and today he was the Sheridan Morley who had been away for years. He was back.
What had caused this? The most likely explanation is that the neural pathways had been reconnected and were finally working again.
But the truth is, even now, that I don’t know exactly why he came back. It was sufficient on that particular Sunday that he had.
Still standing on the stairs, tennis racquet in hand, mouth agape, I tried to take in the new situation. I didn’t want to frighten him by screaming ‘You’re back!’ which is what I wanted to do.
I pretended I always came back to this scene of domesticity which, until his stroke, I always had.
‘Oh, you’re up,’ I said, grinning inanely. ‘That’s good. Would you like me to make you some breakfast?’
‘No, thanks, darling, I got myself coffee and a croissant.’
‘Good,’ I responded, stupidly.
We went to Oxford to see Professor Goodwin the following Thursday. He warned us not to expect miracles, that this upturn could be the long-hoped-for result of the DBS operation or it could be a temporary remission. As usual, he was right.
As the days passed it became clear that Sheridan was not well, but he was much better. He was depressed, but he was functional. It was no longer an all-day job to get him out of bed. While he was fairly low in the mornings, he perked up by theatre time and could once again write reviews.
It was all as good as it was going to get. As the euphoria wore off, I began to see the tell-tale signs of depression taking hold again.
Sheridan was better, no doubt about it, but he was deteriorating again, this time slowly.
But there were enough moments of Sheridan being Sheridan to make it possible for me to return to being, from time to time, me. It couldn’t last, and it didn’t, but it was so much better than what we’d been living with for years that I walked on air.
But What Comes After . . . The Tragic Story Of A Wife, A Husband And The Illness That Nearly Destroyed Them by Ruth Leon (Constable, £16.99). To order a copy at £11.99 (P&P free), tel: 0843 382 0000.
Sheridan Morley died in his sleep from a suspected heart attack in February 2007
Read more: http://www.dailymail.co.uk/health/article-2011235/Brain-surgery-saved-husband-torment-depression.html#ixzz1RF4Pw810
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