At last, the times, they are a changin’. For 25 years the medical profession has viewed depression as a “simple” imbalance or deficiency of serotonin and dopamine. This misguided concept has limited the treatment of depression almost exclusively to the use of anti-depressant medications.
Despite hundreds of published studies showing that these medications are only somewhat effective, the pharmaceutical industry has persuaded my colleagues that they are the best tool available, and we have bought into this paradigm hook, line and sinker.
The result of this is that, over the past few decades, the vast majority of psychiatrists now limit their practice to the prescription of medications, and psychotherapy is largely left to psychologists. This has created fragmented care that does not adequately address the needs of a large number of patients who continue to suffer and be limited in their ability to cope with their daily lives.
This preoccupation with medication as the savior of the depressed, has not allowed us to take a deeper look at the problem to find better solutions.
I was excited to discover, at a recent medical meeting I attended, put on by the Stanford University School of Medicine in San Francisco, (November 19-20, 2010) entitled “Breakthroughs in Neurological Therapies: Restoring Function to the Nervous System,” that a new model, a new understanding, of depression is emerging which hopefully will allow us to now make some progress in this arena.
Dr. Brent Solvason opened up his discussion with what is becoming (finally!) a more complete understanding of depression:
“It is a systems-level disorder affecting integrated pathways linking select cortical, subcortical, and limbic areas and their related neurotransmitter and molecular mediators.”
While the language is a little daunting, what this really means is that the neuroscientists are realizing that depression is created by complicated interactions of different parts of the brain which are not communicating with each other in a “normal” or functional way.
This new definition is arising out of recent research with the use of “deep brain” stimulation for the treatment of depression, obsessive compulsive disorders (OCD), and movement disorders. In academic centers, such as Stanford, neurosurgeons are implanting electrodes into specific brain centers that can be stimulated with electricity to produce improvement and cures. We have long known that electroshock therapy can be effective in some patients with severe depression that has not responded to medication, and some of the patients who have not responded to electroshock are responding to this new approach.
In addition to the implanted electrodes, new studies show that transcranial magnetic stimulation (which only reaches to the surface of the brain), is almost equally effective in treatment.
The essential concept here is that depression, OCD, and other disorders, represent some kind of neurological stuck place, or loop. A simplified understanding of this is that somehow, by injury, emotional overload, chemical and heavy metal exposures, and combinations of these, the nervous system gets caught up in creating, or stumbling upon, a non-functional circuit. And for some individuals, once those circuits are created, they can’t find a way to break out of those neurological loops, and they are mired it a neuro-electrical bog.
The same conclusion is emerging out of our understanding of chronic pain. While we have suspected for a long time that chronic pain is the result of what was called a “reverbating loop”, in which a painful impulse, when it gets to the spinal cord, starts to stimulate neighboring neurons which then turn back on themselves to produce an electrical loop. This loop is essentially self-stimulating, and once in place, even when the original source of pain has long since resolved, the electrical stimulation keep going on, and on, and on.
This leads us to the new concept that what we really need, in order to restore the normal electrical system of the brain is to find a way to “reboot” it. In the same way that we reboot our computers when they get “stuck” in a non-functional loop, we are discovering new ways of doing this with our nervous system.
The exciting research reported on by Stanford University is still based on an invasive neurosurgical approach. While I am delighted that this is putting this information on the map, I cannot imagine that this is the ultimate solution to the problem of depression and pain.
In fact, several newer technologies bring hope that these solutions are right around the corner.
The two that have captured my interest right now are FSM (Frequency Specific Microcurrent) and LENS (Low Energy Neurotherapy System).
FSM uses microcurrent (a thousandth of an ampere) at specific frequencies to break electrical and chemical patterns in the body. LENS utilizes brain-mapping technology to determine exactly which areas of the brain are either over- or under-stimulated, and then applies an almost homeopathic, miniscule electrical current, to move electrical energy through the blocked areas.
I have seen both of these technologies accomplish healing which I had previously thought impossible. Using FSM I have seen patients who have suffered with fibromyalgia for years, get off the treatment table after a gentle hour of microcurrent stimulation, with an 80% reduction in their pain. With repeated treatments, I have seen these patients get lasting results!
With LENS, I have seen patients with severe neurological impairments, due to a wide variety of causes (traumatic brain injury, Lyme disease), be markedly improved within 4-8 treatments.
While we are not certain exactly how these mini-miracles are accomplished, our current understanding is that both of these therapies somehow re-boot the nervous system so that it can return to normal functioning, even after years of illness. This goes along with the current understanding that the nervous system has “plasticity”, meaning that it is capable of creating new connections and being healed. Our older understanding, not yet embraced by the entire medical profession, is that once the nervous system had been damaged, healing was unlikely, and that nerves healed so slowly that it would take 2-3 years if it happened at all.
That these therapies work in hours or days or weeks means that our concept that the nervous system was “damaged” may not be correct. What it implies is that the nervous system is (choose a word) stunned, stuck, irritated, or inflamed, but not damaged. This gives us renewed hope that we are on the verge of being able to offer healing to thousands of suffering patients with our new understanding and new technologies.