“I feel suicidal every day,” says Bev Rutherford. She is 48 and has severe and chronic depression, which she has spent almost half her life trying to treat. Different combinations of prescription drugs have failed to cure it, several cycles of Electroconvulsive Therapy (ECT) have left her with permanent memory loss, and she has tried both psychotherapy and cognitive behavioral therapy, but nothing has worked. She has had to leave her job, and she struggles to feel any emotion for her small grandson. Facing a future of unrelenting misery, four years ago she agreed to have her skull opened and electrodes buried deep inside her brain.
“There are two circuits of the brain likely to malfunction in depression,” explains Dr. Andrea Malizia, Bev’s psychiatrist in Bristol, UK. “With Deep Brain Stimulation we try to inhibit both circuits with electrical impulses.” The procedure begins with a brain scan. Then four holes are drilled in the skull and four electrodes are sunk into the brain. A wire is passed back out through the holes, down the neck under the skin, and connected to a battery installed under the patient’s collarbone. Ten days later, when swelling from the operation has gone down, the battery is turned on, sending out electrical pulses between four and nine volts strong – about as powerful as a TV remote control. Apart from irritation caused by the wire under the skin, and a series of progress tests, life should go on as normal.
“When I’m high I get a burst of energy, but I’m back down by the next morning. I can’t remember the last time I felt normal happiness”
Bev Rutherford, 48, Bristol, UK
Worldwide, more than 80,000 people have had electrodes implanted in their brains, but almost all Deep Brain Stimulation (DBS) operations are performed to treat Parkinson’s disease or other movement disorders. Only about 150 people have ever undergone DBS for chronic depression, and although a 2011 Canadian study found that one in four patients reported being completely cured by the procedure, DBS surgeons are hard to find. Nik Patel, a neurosurgeon at Frenchay Hospital, Bristol, handles Malizia’s patients, but “there is a lot of discrimination around depression,” says Malizia. “The expectation is that people should pull themselves out of it, but these people are severely ill.”
A few days after Bev’s electrodes were turned on, she “woke up on a high.” “When I’m high I get a burst of energy,” she explains, “and I go out and buy shoes. But it’s not a happy high.” And as soon as it came, it went: “I was back down by the next morning. I can’t remember the last time I felt normal happiness.” It is now four years since Bev had DBS, and she still shows no permanent improvement; Dr. Malizia is ready to take things to the next stage.
“Cingulotomy is more extreme,” he says, “because it’s irreversible.” Electrodes are inserted into the brain for this treatment too, but this time they are heated to 90°C and then removed, having permanently severed neural connections. As worrying as it sounds, Sheila Cook, another of Dr. Malizia’s patients, had her depression cured by the procedure. Now she is trying to make up for the eight years of her life during which, in her words, “I was dead inside.”
But Dr. Malizia warns that curing depression does not necessarily bring happiness. Patients can only “go back to being who they were before the illness. Take Winnie the Pooh’s friends. If you were like Tigger, who is always very happy, you will go back to being like Tigger. But if you were like Eeyore, the sad donkey, you will go back to being Eeyore.”
How to fix your brain:
Electric shocks across the brain provoke seizures, followed by a feeling of euphoria. Electroconvulsive therapy (ECT) is the most effective treatment for severe depression, curing up to 80 percent of cases. The relief is often temporary, though (73 percent of those treated relapse after a year), while the side effects are not: on average, 40 percent of ECT patients report permanent memory loss.
It takes 10 minutes to separate your troublesome pre-frontal cortex (which moderates social behavior) from the rest of your brain. Eventually discredited due to its unpredictable and permanent consequences, the method – in which an ice pick tapped in between eyeball and brow bone with a mallet is stirred around – was a widely used treatment for mental disorders worldwide until the 1970s.
In Neolithic times, people were already removing portions of skull to expose the membrane around the brain. In the 20th century, hand-held electric drills made self-trepanation possible: British self-trepanner Amanda Feilding carried out the operation in the 1970s, believing that greater mental acuity could be achieved by increasing the flow of blood around the brain. It did have
an effect, albeit a “very slight” one.
Transcranial magnetic stimulation (TMS) pulses your skull with magnetic waves, which jumpstart your brain’s electrical activity. They also reveal your inner savant: in an Australian study, 85 percent of the university students undergoing TMS were suddenly able to calculate the exact number of more than 100 scattered dots with a single glance.