Depression: Stuck in the present

Depression: Stuck in the present

Hi. It’s been a while.

Several of my friends shared this hyperboleandahalf blog post on Depression.  I really appreciate honest accounts of someone’s struggles with mental health and maintaining a positive outlook.  My relationship with depression has many different facets. The first facet is my mother was bi-polar and struggle with deep depression after coming off extremely optimistic highs of hypomania when I was growing up. Secondly, even though I feel that I carry an optimistic outlook on life, there are certainly times when I’m not so excited about it and that concerns me in those moments. I’ve had many more of those moments this past year after my Mom suddenly passed away in February 2012. In addition, my work on memory has given me the perspective that depression is fundamentally an issue with being ‘stuck’ in the present.  Depression restricts our thoughts to negative memories and makes us not want to think about the future because it’s hopeless, so we get stuck in the present resenting the experiences that make us who we are at that moment and rejecting the possibility that we have the potential to be any better in the future.  Finally, I have been blessed with the opportunity to be part of and see with my very own eyes the ‘corn’ moment in patients with treatment resistent depression. When we turn on a small electrode (about the diameter of angel hair spaghetti) placed deep in their brains in a junction box of the emotional reactivity network (the subgenual cingulate) I’ve seen everything from giggling to crying to a negligible response. My multiple perspectives on depression have given me an interesting take on its affect on other people, on myself, and what it’s like to see the weight of depression suddenly lifted. I thought I’d share a bit of what I’ve experienced.

My Mom could be the life of the party at times and other times the saddest person in the room (if she could even making out of her room at home). It was sometimes difficult to have a mother that had such a range of personality. I feel like it caused me to grow up quick in someways, while my maturity lagged behind in many other ways. One day you literally couldn’t get her to stop talking. She’d talk about anything, everything, and to anyone. She was on a high at these times that couldn’t be matched. Then once something stressful happened in our lives she’d start not wanting to get out of bed and send us out to get food. It was extremely difficult to see her this way, but we just didn’t know what to do, so we’d try just to spend time with her. I think learning to talk with her in those moments and to help her pull herself back up has benefitted me in communicating with the most fragile people I’ve ever interacted with; the patients with treatment resistent depression.

As I mentioned, I’m blessed with the opportunity to work with these patients and see them get better, in some cases almost instantaneously. I see them about a week before their surgery, during their surgery, 1 month later when they get the stimulation turned on for the first time outside of surgery, and after 6 months of constant stimulation. This spacing between interactions with them really lets me see how the DBS allows them to change over time. The best analogy I can think of for my unique perspective on seeing their change is it’s like seeing someone every few months as they workout or loose weight. Even if it’s difficult for you to see your own work out or weight lifting progress because you see it every day, your friend that sees you every few months will notice more change. That’s me. I get to see them every few months as they ‘work out’ their depression.  The immediate changes we see when we turn the stimulation on and the chronic effects are the closest thing I’ve ever seen to a miracle.

You might be asking ‘Why are they coming to see you  every few months?’  Well, they come to see me so I can measure their body’s response to the stimulation and their changes in the processing of emotional information with treatment over the 6 months. In some experiments we show them emotional pictures (positive, negative, and neutral social scenes) to see if they have a bias to the negative pictures and if that bias is reduced after the stimulation. We also just do some basic experiments to measure how their body responds (hands sweating, heart rate changes) when we turn the stimulation on at different electrical currents, a locations 1 mm apart, and at different frequencies. These basic experiments help us understand what systems we are affecting when we stimulate their brains in this particular spot. When they first come in they are the most fragile humans I’ve ever met. It feels like just saying hi could make them break down. This is a stark contrast to their response nearly immediately after we turn it on after a month of healing from the surgery. They can come in after that month the same fragile being and leave making jokes with you. The transformation is unbelievable. It’s almost eery how just stimulating a specific part of their brain (and the down stream parts of the emotion reactivity network) can cause these effects. And these aren’t placebo effects. We sometimes pretend like we are stimulating when we really aren’t and they don’t have the same physiological or behavioral response. They only have those responses to stimulating an incredibly specific part of their brain. If we move the stimulation site one or 2 millimeters down they don’t have the same response. It is mind-boggling. But, the most mind-blowing part of the experience is to see their ‘corn’ moment when we turn it on and leave it on. Many of them start suddenly talking about what they look forward to in the future and say that they don’t want that feeling to go away.

Having a future to look forward to keeps us moving. I’ve written about how the same brain systems for remembering your past are engaged when you think about your future. I’m really curious how stimulating this part of the brains dynamically changing networks, frees up the patient’s ability to mentally time travel back to happy moments and forward to hopeful moments. I know when I’m feeling depressed it feels like nothing could pull me out of it, until something does. I can’t wait to find out what that something is someday. If you know me, you know that my perspective is far from ‘maybe everything isn’t hopeless bullshit’ and my experiences have reinforced that. I’ve seen my mother be pulled out of it by talking with her, taking care of her, and being with her. I’ve felt what it’s like to be pulled out of it by family and friends that love you. And I’ve seen people at the true end of their treatment possibilities be pulled out of it by an electrode delivering the smallest amount of current at the end of a tiny spaghetti noodle sized brain pace maker. There is hope and there are people working everyday to understand how to fight this beast that tricks our minds into feeling like we are going nowhere. Even if it requires putting wires in your head.

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