Chapter 25.

Introduction

Student Video Activities for Abnormal Psychology
true
true
You must read each slide, and complete any questions on the slide, in sequence.

Brain Area 25, Depression and Deep Brain Stimulation

Author: Melanie Maggard, PhD

Photo Credit: Photodisc

Click the Arrow to start this activity

25.1 Brain Area 25, Depression and Deep Brain Stimulation

This video discusses the symptoms of major depression and the use of deep brain stimulation in treating the disorder in those whose depression is chronic. The case of a woman, Deborah, and her struggle to find the right treatment is presented, along with a demonstration of how the procedure takes place.

Brain Area 25, Depression and Deep Brain Stimulation

[MUSIC PLAYING]

DEBRA: I can't lick this. Why, with all I've accomplished, why can't I fix this? And I've tried everything.

NARRATOR: Debra has tried everything. Numerous psychiatrists, antidepressants, more than 30 different kinds, and a dozen electric shock treatments. Nothing worked. Spending up to 18 hours a day in bed, Debra had to abandon her job, stop seeing friends, and had thoughts of suicide. That left Bern taking care of her and the children.

DEBRA: I'm just absent. I don't want to go out with my husband. I don't want to talk. I withdraw.

NARRATOR: Even from him?

DEBRA: Even from him. And my daughters, too.

NARRATOR: Coincidentally, at nearby Toronto Western Hospital, researchers have started a pilot study on a new treatment for people like Debra.

ANDRES LOZANO: What do you think of that, Helen?

NARRATOR: Studying the brain scans of severely depressed patients, Dr. Helen Mayberg, the study's lead neurologist, kept seeing that a small, almond-shaped node was in overdrive.

HELEN MAYBERG: And the area of the brain that was the most active was area 25.

NARRATOR: Area 25, deep in the very center of our brains, is connected to other areas that control sleep, appetite, and drive. All the things that go haywire when someone's depressed.

HELEN MAYBERG: And so you see an inactive frontal lobe.

NARRATOR: Mayberg's theory is if you cool off area 25, you treat the disease. She decided to try a technique called deep brain stimulation that involves threading two thin electrodes through the brain, directly into area 25 and stimulating it with continuous pulses of electricity from a pacemaker in order to jolt it back to normal.

ANDRES LOZANO: We could put an electrode here and here.

NARRATOR: Mayberg's research partner, neurosurgeon Andres Lozano, says it's a far more targeted treatment than antidepressants.

ANDRES LOZANO: The difference is with antidepressants, that the 100 billion neurons in your brain get the drug. And here, we estimate that we're affecting only a few hundred thousand neurons. And so this is a surgical strike.

NARRATOR: We joined her in the OR, the morning of her surgery. A metal frame is placed on her head to keep her immobile.

ANDRES LOZANO: And we're going to give you a bit of a haircut, too, all right?

NARRATOR: Debra will be awake and unsedated during the operation. Once the stimulator is turned on, she can tell Drs. Lozano and Mayberg if she notices any lifting of her mood.

ANDRES LOZANO: Now Debra, you're going to start hearing this drill.

NARRATOR: As they start drilling into Debra's skull, the reality of it all hits her.

HELEN MAYBERG: It's OK, it's OK. Just hold my hand.

DEBRA: I can't believe this is happening. It's just been such a long struggle.

HELEN MAYBERG: Do you feel optimistic now, lying here?

DEBRA: Not really.

ANDRES LOZANO: OK, so this is the electrode here. And we're going to put this in the brain.

NARRATOR: Dr. Lozano slides in the first of two electrodes. A loudspeaker in the operating room erupts with pops and pings. It's the sound of nerve cells talking as the wire hits them. Believe it or not, nerve cells in area 25 have a distinctive chatter that helps doctors know the electrode is in the right place. With Debra, Dr. Lozano tries several settings on the left side of her brain, searching for the sweet spot.

ANDRES LOZANO: All right, anything to report here? Good or bad, or neutral?

DEBRA: Nothing.

NARRATOR: Nothing. And Debra is losing hope. She gets a pep talk from Dr. Mayberg.

HELEN MAYBERG: Do the best you can. Because you're getting yourself psyched out.

DEBRA: Yep.

NARRATOR: They switch over to stimulating the right side of Debra's brain and—

HELEN MAYBERG: What's, what's going on? You look different.

DEBRA: It just seems brighter.

HELEN MAYBERG: Look at me, anything different about me? Look at the colors in my shirt.

DEBRA: Well I'm noticing your yellow mask.

HELEN MAYBERG: Hadn't noticed that before?

DEBRA: Well I had, but they were just kind of—they looked kind of pale yellow, and now they're looking like the hideous color my husband put on the bedroom walls.

HELEN MAYBERG: OK.

NARRATOR: The change isn't dramatic, no bells and whistles. But, it's clear.

DEBRA: I feel lighter. And—

ANDRES LOZANO: Younger?

DEBRA: Younger? Lighter. Lighter, not younger.

ANDRES LOZANO: OK, what else?

DEBRA: Just more optimistic.

NARRATOR: Given the tiny number of patients in this experiment, it's way too soon to call this a breakthrough. Desperate patients could be experiencing a placebo effect. And the doctors could be overly enthusiastic. As for Debra, her recovery has been rough.

DEBRA: It wasn't all roses.

NARRATOR: We stayed in touch with her over the next six months, and dropped in every now and then. There were times she felt well enough to do housework.

DEBRA: I miss you.

NARRATOR: And spend more time with her daughters.

CHILD: Is that your wig?

DEBRA: But then, in the afternoons, crash, in bed.

NARRATOR: And you were telling us that you were very discouraged. You said that you were trying to hold on, sounded a little desperate.

DEBRA: I was not in good shape.

NARRATOR: No.

DEBRA: I was depressed about still being depressed.

NARRATOR: Two months in, Bern was so worried about her lack of progress, he fired off an email to Debra's doctors telling them she was suffering.

BERN: I would spend hours at a time saying, I don't think this is going to work.

NARRATOR: The doctors tried adjusting Debra's stimulator, three times in fact. Her mood would improve, but then she'd slip back, until her fourth adjustment.

BERN: I don't know how to describe the adjustment. But the effect was that she was manic for about four or five days. But she couldn't sleep for three days.

NARRATOR: She didn't sleep for three days?

BERN: She cleaned every closet in the house. She went through all the kid's clothes that hadn't been gone through for three years.

NARRATOR: She was totally hyperactive.

BERN: She couldn't stop.

NARRATOR: So, the doctors put Debra on a drug to settle her down. And by the end of the third month, she felt better. But not completely. Are you still mildly depressed some of the time?

DEBRA: I would say yes. And it's something I struggle with. See ya tonight. OK, bye sweetie.

BERN: Overall, there's an absolute improvement.

NARRATOR: Does she go to bed during the day?

BERN: About half the time, she'll either take a nap, for a couple of hours. Or, she'll retire at six or seven, instead of being in bed the whole day.

NARRATOR: Do you see that, still, that glassy, emptiness in her eyes that we saw when we met her first?

BERN: No, I don't.

NARRATOR: Even I could tell that Debra is a different person. Look at you smile. She has resumed her legal work from home And is joining her older daughter, Mikayla in her taekwondo class.

DEBRA: Because we're going to be black belts, so you have to listen to us. For me, this is a miracle.

NARRATOR: Even with the ups and downs?

DEBRA: Even with the ups and downs.

NARRATOR: Do you think that you're going to improve from here?

DEBRA: I don't know.

NARRATOR: You don't know?

DEBRA: If it got no better than this, it's not perfect. If it got no better than this, it was all worth it.

25.2 Check Your Understanding

Question 25.1

124FYcWOmeAsQY1Cy3c304jRnpO2TvxSN4FxfLVB4bkpjW5vuR6A28NnjCGzm/dvfnWzMcXMVa6PF1Wy7K5oAU3GdBZHo6Viw+MFuhAVDsn9+foMUZNtgfEeWcjmE/ChJ12o2e2g1X+r9CZ22WMbj0tZ00o2y0duh5wbtO4sIfUp0BpuYIANpz8oNvikCunmhoIWPZMRetN9y09w5Ggxca8J1eFLuh0mD7GczlK9Z401D67I
Correct!
Incorrect.

Question 25.2

G4996e8+2pKe1DUukzbfmdxT+y9EdUjTSvCpLqTzN3RvzZQGKyyWNuvm9txW4J/s7VhzoN9It3s8bWEyKNNFMwR+pseKy2Ei3fyg+wPMQv3mZTh4QqihS+syo0RzI6VIAW7crX5437kN8aX3Fh+hQa+m6PY5baxLv8RH3nu54XY=
Correct!
Incorrect.

Question 25.3

zpnNarZFLJtcTImwO+46RWXReAQ9p9b4DCLAZ9PN4eXIwDAXNBIlAsJUz5ezflGtOTgidUO9fmmVJ86OcvXSVXbEiM4KUo5bmEfuAcQK1++nA9vcjA2ZpGYCBuPa7ZT09NYWFtBM+SxzIqWgcMg7bjIh2QnNTBc/uOundANHlHf2XidI1uqC7FGoitTwa9QeIweIKYTSE2py1KcB2sVTVbo/DJXpSicVRUZI6lUbAKf4r5owvdcATQ==
Correct!
Incorrect.

Question 25.4

C+Vcr8fSPHpSfHV65KZg8X97DIOG50yXdlThM7wiFt4ASMXHTDS/YD3eiUpOIXasoSya46lKoZKNYGn4i4ULOGpedJX2YrtPbbf9hmAj1S8PYYI/uvzVoH33w81EM/8a/6NUSsygTo9Z5ihS19aH6XKA3blEM/BuGe8Y8CFqLW0Uah4iON3nb2m0gn6UmLhlgRnkWyMQl68Hu8Pf7VdOS2TMfj8NFyh3pLxsIQJ6XbcfTbZ7BxB2xiLUcm2GKyKjXB7sN5nRrZ75YA4bLMUtJGKpOufAUdznkOdEkEDPi9ULY5LMdk1bmxAIq0IsgHRS8JwbfbzQMsDjqE3dDCdlJTcjNBtFHnN1ZEZIy8aqnWjYLIpKHwRm19uM9bPKh28zvvkJ+g==
Correct!
Incorrect.

25.3 Activity Completed!

Activity results are being submitted...