Experimental Treatment for Major Depression

Edward Agarwala, at the Cleveland Rock Gym.
Edward Agarwala, at the Cleveland Rock Gym.

(Sounds of climbing gym)

AGARWALA: Let’s see if I can do something a little more challenging…Maybe not…(grunts)

I’m at the Cleveland Rock Gym with Ed Agarwala. He’s scaling a make-shift boulder with an impressive overhang. It’s kind of a metaphor for what he’s been struggling with nearly all his life.
Agarwala’s got major depression. In high school, he had to talk himself through mental exercises just to get up in the morning.

AGARWALA: It would be like, you know, I just didn’t feel like I could get out of bed. So I had to start with something as simple as…I don’t have to get out of bed, just if I could move my hands and feet a little bit, you know that’s just the first step.

Some days he didn’t make it out of bed. His depression got so bad in college that he finally sought treatment.

AGARWALA: My girlfriend at the time saw how bad I was. I talked to her about, that I might actually commit suicide and that it wouldn’t be her fault, and she convinced me to please go see somebody.

This was the start of a long and largely fruitless search.

AGARWALA: I have tried every class of medication, to no effect.

We’re talking: SSRIs like Prozac, Zoloft, Paxil, drugs like Wellbutrin, the generic doxepin, or Marplan or Cymbalta.

He tried intensive psychotherapy, fish oils, even another class of drugs known as stimulants.

He also tried a procedure called electroshock therapy, or ECT, where doctors create “mini seizures” in the brain. This can be an effective--if extreme--treatment for depression. But it didn’t really help Agarwala.

His depression was pushing him to a breaking point.

Then one day he read about a procedure called “deep brain stimulation” in the New York Times.

It’s an experimental therapy for people with severe depression, for people who’ve tried most everything else.

So Agarwala enrolled in a trial at the Cleveland Clinic. And now?

AGARWALA: I am a cyborg.

He’s mainly joking, he does have implants IN his brain. This is what deep brain stimulation is all about.

AGARWALA: I have batteries in my chest and wires in my brain that affect my mental and emotional function.

The battery packs are about the size of cell phones, one embedded on each side of his chest.

Deep brain stimulation is already FDA approved for treating things like Parkinson’s and tremor. It’s being studied for other diseases, like severe depression, bipolar, Tourette’s.

Agarwala describes the moment, after several hours of brain surgery to attach the electrodes, when doctors flipped the switch:

AGARWALA: You feel the current run for the first time and it is exquisite. I mean the sadness just disappears.

Agarwala’s doctor at the Clinic, psychiatrist Donald Malone, takes a more cautious tone:

MALONE: You know there is no magic bullet. Now for given individuals could this be a magic bullet? Yes, yeah, it could be.

Malone says the therapy looks promising in some cases. He and others have found modest to dramatic improvements in patients.

MALONE: The reality is that depression is horrible. And depression of this severity is really horrible. It’s every day and it’s awful and people just want out.

Dr. Peter Kramer, a professor of psychiatry at Brown University, says deep brain stimulation is a “tool in progress” for severe depression.

KRAMER: I think this is interesting but I really think anyone that approaches it should know that it’s experimental, and that it’s not first or second rank but it’s sort of a last resort.

That’s because it is brain surgery, and other depression treatments are much more tested and have more data to back up their use.

The hard evidence for deep brain stimulation has yet to come in but researchers hope to have some reliable data soon.

Dr. Malone, from the Clinic, is part of a multi-site randomized control trial, and he says they may release results sometime this year.

Medications and psychotherapy remain the most effective treatment options for most cases of depression.

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