When it comes to issues of identity and authenticity in DBS, let patients have a voice

By Ryan Purcell

Reconstruction of DBS electrode placement, image courtesy of Wikipedia

Deep brain stimulation (DBS) is an extraordinarily popular topic in neuroethics. In fact, you could fill a book with all of the articles written on the subject just in AJOB Neuroscience alone (and the editors have considered doing this!). A special issue on the topic in AJOBN can be found here. Among the most widely discussed neuroethical issues in the DBS arena are concerns over the effects on patient identity and authenticity. But perhaps one perspective that has not been fully represented in the academic literature is that of the patients for whom this is actually their last hope to find a way out of a profound, debilitating and often years-long episode of depression. At February’s Neuroethics and Neuroscience in the News journal club, Dr. Helen Mayberg spoke passionately about the approach that led her team to attempt DBS for major depressive disorder (MDD), the ensuing media response, and how that has affected her ongoing work to improve the technique, better understand the etiology of MDD, and allow patients to get back to their lives.

The DBS for depression story goes back more than a decade and began in Toronto. Dr. Mayberg’s group consistently found cingulate area 25 to be differentially active in mood studies; it was tonically active in depressed patients and became transiently activated when healthy subjects were saddened while in the PET scanner (Mayberg, 1997). The idea was put forward that if the activity of this area could be reduced, perhaps it may lift some patients who had exhausted all other options out of the depths of the most debilitating degrees of depression.