Habituation
Jan
Thanks for your reaction. I’m sorry to read that your depression
hasn’t lifted with dbs. The only people who fully understand what a
devastating impact TRD has on your life are TRD patients themselves,
so I think I can truthfully say that I know what you’re going through.
Thanks also for your link to Sum Thing To Talk About. I found the page
on stigma especially interesting and recognizable. Many people still
believe that the patient is responsible for his/her depression and, as
a consequence, also for his/her recovery. Even some psychologists and
the like do not always seem to realize that depression is a genuine
disease. A psychiatric nurse once beat the lot by suggesting that I
couldn’t be very depressed if I could be so angry. She had been giving
me the you-can-only-cure-yourself crap until I was so fed up that I
told her to cut it out (in less polite words, I must admit) and that I
would have made myself better a long time ago if that had been in my
power, “’cause I’m not the moron you seem to take me for”. She was not
amused. I got a reprimand in my weekly report and was labeled an
arrogant patient. I’ve gone through the table of contents of “Healing
the Stigma for Depression” and I will certainly read it. By the way,
they tried VNS on me back in 2004, but all it gave me was a left vocal
cord paralysis which left me with almost no voice for over a year. Now
luckily my right vocal cord compensates for the loss.
I too was depression free for about a week after my surgery due to
microscopic lesions in the target area, but my doctors told me that
that could be a sign that electric stimulation of the same area would
have a similar effect. And it did. So I suppose I’m the first dbs for
depression patient you meet with a good outcome. Still, it’s a fragile
balance, especially with the “habituation” I wrote you about
yesterday. (I think “habituation” is a more suitable word than
“adaptation”, but I’m not a native speaker of English so correct me if
I’m wrong.) I called my doctor yesterday to ask her if it would be a
good idea to turn the stimulators off for a while and she thought it
was definitely worth a try. So around 4 p.m. Monday I switched off the
current and within minutes I was as depressed as I was before my
surgery. It’s quite amazing what a huge difference 2 x 5.5 V at the
right spot in your brain can make. This morning I switched the current
back on but at a much lower voltage, just to keep it bearable. Now I
hope that when I turn up the voltage again after a few days, the
antidepressant effect will be as great as before. I’m seeing my doctor
on Friday to discuss the result.
From what I’ve learned up to now, fine-tuning is extremely important
in the case of dbs. Some of the stimulation parameters my doctors
tried on me filled me with despair, triggered off panic attacks, gave
me nightmarish thoughts, etc. Other settings calmed me down, made me
sleepy or gave me a feeling of confidence. And all these effects
disappeared within seconds as soon as the current was lowered or
switched off. So personally, I’m pretty sure it is possible to
influence the emotional centers of people’s brains. The problem is
that the effects are different from person to person. I only know one
other dbs patient, from the Toronto group, and her stimulator is on at
the same voltage day and night. She’s not entirely depression free,
but much better than before her surgery. So if I were you, Rich, I
would not give up and experiment with a 3, 4 or 6 hour cycle, like you
wrote yesterday. I think it’s certainly worth a try and what have you
got to lose? I was a little amazed about the frequency of your follow-
up visits. For many months on end I had to go to the hospital about
every week to assess the previous week, fill out the depression rating
scales and try out new stimulation parameters. Since the final phase
of the study is over, I only have to go back for a routine checkup
every three months. But I can always see my doctor within days when
things go wrong.
Take care,
Jan