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Changing Minds: Area 25

Changing Minds: Area 25 Oct. 1, 2006(CBS) Eighteen million Americans suffer from major depression. Most of them are treated successfully with a combination of “talk therapy” and anti-depressant drugs. But millions of Americans – possibly as many as four million – are afflicted with what is known as “treatment-resistant” depression. For them, nothing works, not even electric shock treatments. They endure lives of debilitating sadness and some end up committing suicide.

But as correspondent Lesley Stahl reports, early results from an experiment in Canada have raised hopes for an answer to their suffering. It involves surgery on a region of our brains called Area 25. And, for the small group of patients who have signed up, the risks seem worth taking, because this is their last resort.

“It’s kind of, for me, just a feeling of sadness, hopelessness, overwhelming,” says 49-year-old Debra Prupas of Toronto. She was diagnosed with depression 15 years ago. It would seem that Debra had little to be depressed about, with a career as a high-level lawyer, a new husband, Bern Grush, and two daughters adopted from China.

“I call myself the great imposter,” Prupas says. “I could fake my way through it. People – nobody knew. And then in the past few years, I’ve not been able to do that. I can’t even get out of bed.”

Debra has tried everything: numerous psychiatrists, anti-depressants: 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.

“I’m just absent. I don’t want to go out with my husband. I don’t want to talk to – I withdraw,” she says. She even withdraws from her daughters.

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

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 over-drive.

“The area of the brain that was the most active was Area 25,” Dr. Mayberg explains.

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. 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.

Mayberg’s research partner, neurosurgeon Andreas Lozano, says it’s a far more targeted treatment than anti-depressants.

“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,” he explains.

And like any brain surgery, there are risks, like stroke or infection.

As a nurse who understood those risks, 41-year old Deanna Cole-Benjamin says she went into surgery scared. “Knowing that if this doesn’t work, then what else is there,” she says.

Deanna, a wife and mother of three, was so depressed, she had spent four years in mental hospitals, undergoing repeated electric shock treatments.

She estimates she had around 80 such shock treatments.

Two years ago, just before she became one of the first people to have the surgery, Deanna said, “I just feel numb, I feel empty, I feel worthless.”

Today, she is one of the experiment’s most striking successes.

With 15 patients treated so far, researchers claim 10 have responded positively. And most of them were, like Deanna, depression-free within six months of surgery, with no apparent side effects.

When Debra heard about the experiment, she begged to be part of it. 60 Minutes spoke to her a few days before her operation last March.

“You don’t feel, to me, like you’re really afraid,” Stahl remarks.

“I’m afraid of it not working. I’m very afraid of it not working,” Debra says.

60 Minutes joined her in the O.R. the morning of her surgery. A metal frame is placed on her head to keep her immobile.

Debra will be awake and un-sedated during the operation. Once the stimulator is turned on, she can tell Doctors Lozano and Mayberg if she notices any lifting of her mood.

As they start drilling holes in Debra’s skull, the reality of it all hits her.

“That’s okay. That’s okay. Just hold my hand,” Dr. Mayberg said to Debra.

“I can’t believe this is happening,” Debra said. “It’s just been such a long struggle.”

Yet, while lying on the table, Debra acknowledged she was not really optimistic.

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.

As he turns on the electric current, Dr. Lozano hopes Debra will feel the flash that Deanna did, the moment her depression lifted.

“I was distinctly hit with being overwhelmed with color in the operating room,” Deanna recalls. Before, she says she had been seeing everything in black and white and gray.

“But I didn’t know it until it was given back to me,” she says.

With Debra, Dr. Lozano tries several settings on the left side of her brain, searching for the sweet spot.

But Debra felt no change in her mood and began to lose hope. She got a pep talk from Dr. Mayberg.

“Do the best you can. ‘Cause you’re getting yourself psyched out,” she told Debra.

They switch over to stimulating the right side of Debra’s brain and suddenly she perked up. Things seemed brighter in the operating room, and more colorful.

Asked if she had noticed Dr. Mayberg’s yellow mask, Debra says, “Well, I had, but they looked kinda pale yellow. And now they’re looking like the hideous color my husband put on the bedroom walls!”

The change isn’t dramatic – no bells and whistles, but it’s clear.

Debra noted that she felt lighter and more optimistic.

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.

“Now, I understand that you and Dr. Mayberg are applying for a patent in the United States. So you would benefit financially if this works?” Stahl asks Dr. Lozano.

“My university and myself would benefit, if it worked, yes,” he says.

Asked if there is a conflict, Dr. Lozano says, “Of course, whenever you have an idea, whenever you have a innovation, you, of course, want it to work. That’s why it’s so important for this to be reproduced elsewhere in an independent manner by other groups, and other centers.”

Medtronic, the company that makes the device, plans a full-scale clinical trial in the U.S. within a year. If the results are positive, analysts predict sales could be several billion dollars a year.

As for Debra, her recovery has been rough.

60 Minutes 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 and spend more time with her daughters.

But then in the afternoons, she would crash. “I was not in good shape,” she says. “I was depressed about still being depressed. And I was like, well inside I’m thinking it worked in the hospital. Why isn’t it…where is it?” Debra adds laughing.

Two months in, Bern was so worried about her lack of progress, he fired off an e-mail to Debra’s doctors, telling them she was suffering.

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.

“I don’t know how to describe the adjustment but the effect was that she was manic for about four or five days,” Bern recalls. “She couldn’t sleep for three days.”

“She cleaned every closet in the house. You know, she went through all the kids clothes that hadn’t been gone through for three years,” he remembers. “She couldn’t stop.”

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.

She acknowledges that she is still mildly depressed some of the time.

But her husband says, “Overall, there’s absolute improvement.”

Does she go to bed during the day?

“About half the time she’ll either take a nap for a couple of hours, or she’ll retire at 6 or 7 instead of being in bed the whole day,” Bern says.

And he no longer sees that glassy emptiness in her eyes that Stahl saw when she first met Debra.

That kind of improvement is enough for the doctors to put Debra in the experiment’s success column. They say tests she took at the three-month mark showed a 50 percent reduction in her symptoms.

“Well, she is doing very well,” says Dr. Lozano. “She is going back to her hobbies. She told me she’s doing things that she hadn’t done in 15 years. But she’s still a little depressed. She has still a mild degree of depression.

“We were filming her yesterday and after being quite energetic, she disappeared to her bedroom and we didn’t see her again for hours,” Stahl remarked. “To me a person who goes to bed in the afternoon is not mildly depressed.”

“I think that she may, she still has a degree of depression. She’s not in remission, she’s not below that threshold,” Dr. Lozano says.

And, Lozano says, she may never be. On top of that, he says, this is not a cure. So far, none of the patients has been able to turn off the stimulator without their depression returning within days.

Still, even Stahl could tell that Debra is a different person.

She has resumed her legal work from home, and is joining her older daughter Mikayla in her Tae Kwan Do class.

“For me, this is a miracle,” she says, even with the ups and downs.

“Do you think that you’re gonna improve from here?” Stahl asks.

“I don’t know,” Debra says. “It’s not perfect. If it got no better than this? It was all worth it.”
SOURCE:-

Produced By Karen Sughrue
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