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Deep brain stimulation for depression, mood disorders can be ethically distorted: shots



  Depressed man and image of neural networks in the brain.

Christina Chung for NPR / NPR

  Depressed man and image of neural networks in the brain.

Christina Chung for NPR / NPR

Our thoughts and fears, movements and sensations arise from the electrical collisions of billions of neurons in our brain. Electricity flows through neural circuits to manage these actions of the brain and body, and some scientists believe that many neurological and mental disorders can arise from dysfunctional circuits. these defective chains reach deep into the brain and push the flow into a more functional state by treating the underlying neurobiological cause of diseases such as tremor or depression.

The idea of ​​changing the brain for better with electricity is not new, but deep brain stimulation takes a more purposeful approach than electroconvulsive therapy introduced in the 1930s. DBS seeks to correct specific dysfunction in the brain by introducing precisely defined electrical pulses in certain regions. It works by the action of a very precise electrode that is placed surgically deep into the brain and is usually controlled by a device implanted beneath the collarbone. Once in place, physicians can externally adjust the impulses to the frequency they hope to fix the defective circuit.

Listen: The brain of the remote control

depression, which registers for a deep brain stimulation study. History describes how it is to be able to adjust its mood by adjusting your device's settings. Listen to this story here .

The FDA only approved deep brain stimulation for several conditions, including movement disorders – dystonia, essential tremor, and Parkinson's disease symptoms – and treatment. resistant epilepsy. Now many scientists in the United States and around the world are experimenting with mental health technology such as depression or obsessive-compulsive disorder.

The results of clinical trials have so far been mixed: Some patients say they have been completely transformed. others do not feel or worsen.

However, research continues and the potential of technology to change immediately and powerful mood raises ethical, social and cultural issues. NPR talks to neuroethicist James Jordan, head of the Neuroscience Research Program at Georgetown University Medical Center, about this new technology and its potential benefits and harm when used for psychiatric treatment. In addition to his work at Georgetown, Jordano has consulted the American military on these technologies and their possible use.

This interview includes two separate conversations with Jordano, one by Alix Spiegel and one by Jonathan Lambert. ,

What is deep brain stimulation and how does it work?

Scientists have stimulated the brain for as long as now, but historically it's pretty rough. The neurosurgeon [would] touches a brain area with an electrode and sees what has happened, what kinds of functions are affected. But we did not have a detailed picture of what we wanted to target in the brain, and the electrodes themselves were not very accurate.

We now have a much more detailed map of the neural networks and nodes involved in different pathologies. [like Parkinson’s, obsessive-compulsive disorder, etc.] or different thought patterns or emotions. Deep brain stimulation provides a very specific and very precise way to use electrodes to deliver electrical current to and around a small set of brain cells to incorporate or modulate their activity

Modify the chain and modify the behavior. The goal is to use DBS to modify the schematic in such a way as to improve the symptoms in a very specific and precise way.

How do you know what types of specific inputs do you want the electrode to deliver, and where in the brain to deliver them?

There is an old saying in brain science: "When you see a brain, you see a brain." This is certainly true, but all brains have much similarity on which individual variations are built because brain structures are changing and developing as a result of experience.

So when we implant a device, we know we're usually, but since the patient is awake while we implant the device, we can adapt it to know exactly where to place it for the desired effect. A finer setting, in terms of the type of stimulation that can be done, can be done after an operation because the device can be set externally.

Although not yet approved by the FDA for them, studies are ongoing to treat mental disorders with DBS? Many studies have certainly found evidence that DBS can be effective in treating disorders such as Tourettes syndrome, obsessive compulsive disorder and even depression. Patients report a reduction in symptoms, but there are still a lot of questions to answer. For example, when we treat with DBS? Early in the development of a disorder? Later, after exhausting other options? These are questions that still need a response

How would you explain the difference between how antidepressants affect the brain and how does deep brain stimulation work?

A medicine like prose or antidepressants is basically like throwing water on your face to drink water. Using something like deep brain stimulation is like putting a drop of water on your tongue. We can increase the specificity and precision … and in many ways the precision and specificity of deep brain stimulation make it a more effective tool. It can be switched on and off. It can be adapted in a very short time so it can be a more flexible tool that allows much more precise mood control.

And, compared with antidepressants, are there differences in moral or ethical implications when using a treatment that allows us to act so specially about mood?

The specific is power. And the moral duty that comes with great power is enormous. The responsibility to best understand what you do not only at the neurobiological level, but also at the existential and even social level. What are you doing? Are you creating a new normal [in terms of mood]? And if you are creating a new one, do we have what we will call "ethical equipment" to do that? In some cases, I think yes, but I think that in other cases you will begin to see that it is necessary to develop new ethical principles because of the potential and reality of how these things are used. For example, expressive creativity. Is there an ethical principle of amateur art … that I can define myself and say that I want to be created in these ways? Do you mean theoretically, in the future, can I go to a doctor and say that I want to be a great artist?

Now we are not quite right now, but I can certainly go to a doctor and say that I want to be more outgoing, I want to be less depressed. I'd like to be happier everyday. I would like to feel more enlightened in my daily experiences … In an open society, we say that one should be able to define, "I want to be this" and this is an instrument to get there? Perhaps, but then we also have to balance this. What about the others? … This returns to the question of justice. Can anyone get this? Who will get this?

What can go wrong with this technology? What should we worry about?

Well, it's neurosurgery, and there are certainly risks that go along with that, infection, procedural problems. Goals can be omitted or misidentified. These are risks that come with the territory.

But there are a few more specific cases for DBS. What if you get effects you did not expect? By stimulating area X, it is possible to get an overflow effect that modulates other things related to that, such as personality, temperament, character, personal preference. There have been reports of anecdotal reports of such things but they are rare. So the implanting of a DBS device could have some unexpected consequences for our tastes or personal characteristics like introversion and extraversion

One of the most famous cases, for example, was a man whose musical taste has nothing to do with country music. And after a deep brain implant for a movement disorder, [the person] developed a true pathos for Johnny Cash's music and was entirely aesthetics of Johnny Cash. Could these things happen? Of course it is. The brain works as a coordinated set of nodes and networks that are mutually communicative and reciprocal. So changing the electrical activity of the local field in one area does not necessarily have to be completely discrete by wiring, if you wish, by the type of activities and functions of other brain areas.

Can treatment with a DBS device change more than our mood, but also our personality?

Yes, although we need to ask ourselves whether these changes are due to the positive effects of DBS. If someone with Tourettes was an introvert and then implanted DBS and became more extroverted and more socially involved, is this a side effect of DBS? Or because they no longer have the burden of being someone with a constant verbal teak?

The DBS also raises questions about personal autonomy. Will we get cases of people who say that "my deep brain stimulus has made me do it?" Perhaps. But very often patients report that the condition they had, which DBS heals, breaks their autonomy more than they think is a deep brain stimulation. Since they can affect the state of the mood at any of the electrical current levels in the device, how do they know what level to set?

Up to the point of clinically significant therapeutic improvement. Just as we would determine, for example, levels that one can use through another therapy, [like] cognitive-behavioral therapy. Does the person work? Whether they say, "Yes, I feel better, my mood is better." The same would be true for the drug, but it is stronger because you directly influence those nodes and nets that look like a substrate to what causes this person's mood. So you want to be cautious. The general tenor in the field starts low and runs slowly.

Beyond DBS, where this technology eventually can go?

There is a market for doing it alone, if not, not for deep brain stimulation but transcranial electric stimulation. This shows that there is an increased interest in neurotechnologies that are not simply health-friendly, but change the key aspects of knowledge, emotions and behavior. This is sometimes called cosmetic use or design use of neurotherapy. [If] I do not like key aspects of personality, [such as being shy] Can I change that, for example by using these neurotechnologies? These things come and is not in the near future – now there is interest.

What traps are we facing if this technology becomes more and more widely used?

Errors will occur. We hope that we will be bright enough to correct and recognize them when they occur not only in terms of technological and scientific mistakes, but also ethical, moral, and legal mistakes. In many ways this is something like a brave new world of abilities. And I think we have to be very careful about the potential of this potential. Yes, this can lead to some really wonderful things, but also, along with this … if used for cosmetic purposes such as self-improvement, can this lead to potential violence? I can guarantee that things will happen that are very, very problematic and in some cases devastating. Do I believe that the net effect will be beneficial because we will respond adequately to these mistakes we make? Yes, that's my hope. Do I know we'll do it? I do not know.


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