# Deep brain stimulation treatment



## azteca (Dec 28, 2013)

Has anyone here looked into deep brain stimulation as a treatment? I'm not sure if it's been approved for dp or even trialed. But it is a very promising new treatment for many psychiatric and neurological disorders. They are finding that many disorders have a specific area in the brain that is over or underactive and they stimulate it. For those with numbness and possibly even the blank brain/feeling numb to your own thought process this therapy might work. Studies have shown a specific area in our prefrontal cortex is overactive, inhibiting emotional response. We could stimulate this and possibly be cured. Recently I was caught up in thinking the hpa axis was behind all my problems but that doesn't make sense because my physical energy is not bad, and even people with addisons/no cortisol don't have the blank mind symptom. Less invasive options are tms and a something called ices


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## TDX (Jul 12, 2014)

DBS is indeed promising and I think it should be tried for DPD, but unfortunately nobody seems to be interested in doing so.


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## azteca (Dec 28, 2013)

That's unfortunate. I may make a tms unit. They charge insane amounts for this but you can make it at home for 50 dollars


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## azteca (Dec 28, 2013)

I need to find some way to get my prefrontal cortex stop what it's doing. I have to rely on drug use to be able to feel connected to life and not be numb to my thought process


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## TDX (Jul 12, 2014)

Haven't I told you to try precription drugs to achieve relief?


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## azteca (Dec 28, 2013)

I don't really like the way adderall makes me feel. But yes it does reconnect me


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## hopefuluk2 (Aug 20, 2015)

azteca said:


> I don't really like the way adderall makes me feel. But yes it does reconnect me


how does adderall make you feel?


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## azteca (Dec 28, 2013)

Sort of wired and then I feel depressed on the come down. I have also developed insomnia in the past year so adderall would only make that worse


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## Ningen (Apr 16, 2015)

I've been waiting for someone to bring up DBS. I've seriously been thinking that it could be a/the promising treatment to depersonalization, even though it hasn't been researched or tested on patients with depersonalization, as TDX mentioned. I once thought DBS to be too risky, but now I'd certainly be willing to try it if all else fails.


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## azteca (Dec 28, 2013)

I believe it has been trailed for 'anhedonia' and was effective by stimulating the nucleus accumbens. So we could lie and have this done. But I think it would be more effective to stimulate the Ventrolateral prefrontal cortex


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## sunjet (Nov 21, 2014)

I'm a junior neurosurgeon, my thesis is on deep brain stimulation and I will specialise in the future in functional neurosurgery.

Studies have been made with some positive results for depression/ocd but only in cases where any other methods won't help.

You'll not be able to do DBS just because you want. And do you understand that it involves stimulating deep subcortical nuclei that also responds for behaviour, intentional movement and execution of certain actions. You can get serious adverse effects worse than DPDR.

There will be alot of studies till we find the right target then after that we'll make some criteria for choosing the right candidate for such an intervention. And for sure one of them will be drug-resistant DPDR and DPDR that interfere with your everyday activities.

But like studies say that DPDR is caused by depression (sometimes with anxiety), maybe if stimulating the area responsible for depression will make DPDR go away. But again, in severe cases, where it can't be treated with drugs, psychotherapy and any other kind of therapy.

Candidate selection is very strict and delicate, it's not easy and it's made by an entire team of neurosurgeons, neurophysiologist, neurologist, psychiatrist.

DBS is the final resort.


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## azteca (Dec 28, 2013)

Sunjet, what is your opinion on tms to the Ventrolateral prefrontal cortex instead? Supposedly you can make a unit at home. And my next step will be to try wellbutrin


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## azteca (Dec 28, 2013)

The only meds I've used are basically illicit substances. I don't figure I'd respond to most Dpd meds because I don't have many of the symptoms of being unreal. I basically am just numb to my thought process/feel disconnected from life. Wellbutrin is supposed to be good for bringing emotions back.


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## sunjet (Nov 21, 2014)

TMS is very promising but doens't work for all, and it's also a last resort when you got some drug-resistant neurological disorder like severe depression or/and dpdr.

I would not try to build such device because you can mess with the coils, magnetic fields, power and implulse cycles which are needed for the stimulation. You can make things worse.

First try psychotherapy, medications and any other ways of "beating" it.


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## Zed (Jul 25, 2015)

azteca said:


> I don't figure I'd respond to most Dpd meds because I don't have many of the symptoms of being unreal.


There are no dpd meds


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## azteca (Dec 28, 2013)

So my two best options may be wellbutrin or tms. Im still interested in getting an fmri to see if i have a specific area of the brain thats causing this


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## TDX (Jul 12, 2014)

> So my two best options may be wellbutrin or tms.


There are several other medication that modulate dopaminergic transmission that you could try.


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## azteca (Dec 28, 2013)

Which ones? Have u tried them?


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## TDX (Jul 12, 2014)

> Which ones? Have u tried them?


Some of them.

I think of for example Aripiprazol, Amisulprid, Selegeline or Methylphendiat. Bupropion might be too weak, but it's worth a try.


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## azteca (Dec 28, 2013)

Ok thanks. I tried curcumin which is an maoi like selegeline. But it had no effect. I need something to signal dopamine release but I don't like adderall.


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## azteca2 (Apr 8, 2016)

So I have been reading research on deep brain stimulation being effective for anhedonia and apathy by stimulating one of any of the following areas:nucleus accumbens, prefrontal cortex and anterior cingulate . This would likely be effective for those of us with emotional blunting or blank mind . All of these structures are part of our emotional circuitry. The anterior cingulate stimulation has been particularly effective in depressed patients who have increased activity in this region. Apathy is the opposite, we have decreased activity in this region.


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## TDX (Jul 12, 2014)

Unfortunately it's still experimental and there is no interest to use this treatment against Depersonalization Disorder.



> Apathy is the opposite, we have decreased activity in this region.


Sierra and Berrios conjectured that underactivity of the anterior cingulate might cause the blank mind, but there is no proof for this.


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## azteca2 (Apr 8, 2016)

U could possibly get diagnosed with depression or anhedonia. Deep brain stimulation is in stage 3 of clinical trials I believe so it may not take too long to be approved . And i think it's very likely that blank mind is due to the anterior cingulate. This is the area that gives salience to stimuli /makes you care about things. That's why it is implicated in apathy. And I think blank mind is just a cognitive symptom of apathy that some people have


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## TDX (Jul 12, 2014)

> U could possibly get diagnosed with depression or anhedonia. Deep brain stimulation is in stage 3 of clinical trials I believe so it may not take too long to be approved . And i think it's very likely that blank mind is due to the anterior cingulate. This is the area that gives salience to stimuli /makes you care about things. That's why it is implicated in apathy. And I think blank mind is just a cognitive symptom of apathy that some people have


I was offically diagnosed with severe depression, even after I provided the psychiatrists with information about Depersonalization Disorder. There is no certainity if my symptoms emotional numbness + blank mind are really Depersonalization Disorder. There are some reasons that speak for this, but others that speak against this. That's why I finally "accepted" the depression diagnosis (also because it gives me access to more medications), but as many people here also have numbness + blank mind (but often also other symptoms) I'm still not sure.

I see it this way: If I have tried all possible medications and Electroconvulsive Therapy I will also try to get Deep Brain Stimulation. I promise.


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## azteca2 (Apr 8, 2016)

I would try deep brain stimulation over ECT. ECT effects are usually not long lasting and you could end up with cognitive difficulties or missing years of memory . And I am cautious with medications. SSRIs are known to induce apathy. And there's a lot of testimonials of people on the internet who describe their mind as a numb void after taking antidepressants and antipsychotics .


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## Ianar (Oct 31, 2015)

TDX: your symptoms are similar to mine though I do not have a completely blank mind, though it is slowed and imagination is severely compromised. For instance when I close my eyes to sleep there's not much going on.. Mostly 'blackness' whereas before my mind was extremely busy. I also have complete emotional numbness and anhedonia, and generally feel brain dead. These symptoms would seem to fit the diagnosis of depression with melancholic features; psychomotor retardation can cause thoughts to slow way down or stop altogether. I also hang around here at times for the same reason, as you often see these symptoms discussed in depersonalization. I actually frequented this board as far back as 2005 I believe, when I had some more textbook depersonalization symptoms which were transient. In my opinion your diagnosis is likely correct, although it is fairly uncommon (not to mention unlucky) for younger people to get melancholic depression; I believe it's far more prevelant at 60+ years.

I would be interested to know if there was any precursory events or stresses that preceded your symptoms, not even specifics, and if there was a gradual or sudden onset. You have the nearest symptoms to me I've seen on this board so I guess it would be "interesting" to know. No problems if not. One of the other reasons I initially suspected depersonalization, was my symptoms had a gradual then very sudden onset, which tends to be the case when people become depersonalized. I had lots of life stresses over the past few years, and a period of chronic anxiety, when one evening my mind simply "broke".


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## azteca2 (Apr 8, 2016)

I may get a SPECT or fmri to image my brain activity just out of curiosity


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## azteca2 (Apr 8, 2016)

So I've been reading more about DBS and it seems a thorough review of the literature shows that it's not quite as safe and effective as originally presented . Here is an article with more information. http://www.madinamerica.com/2015/09/adverse-effects-perils-deep-brain-stimulation-depression/. I think I may try vagus nerve stimulation which is already approved. It doesn't improve everyone but SPECT imaging does show increases in activity of the basal ganglia-frontal lobe circuits after 6 months .


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## TDX (Jul 12, 2014)

That's a reason why it's good to do ECT before. You could lose years of your memory in extreme cases, but if it works it's certainly worth it. Since I'm ill I write diary as an "external memory", because I sense that ECT lies before me.

They also seemed to use the Cg25 area, which seems to more involved in feelings of sadness than in anhedonia. Interestinlgy one patient got depersonalization symptoms because of DBS.

I still think that psychosurgery by DBS might be the hope for many people with treatment-resistant psychiatric disorders. At the moment the brain stimulation group at the university at Bonn had some good results with DBS for depression at another brain region.

if I would be able to get DBS I would certainly do it, if everything else failed, but certainly not at the Cg25. If the result is even worse than my current "life" I will just kill myself. If I cannot get it I would also kill myself by no later than a max. duration of my disorder of 10 years. There are 8 years left. I think this is a reasonable time frame to expect the approval of DBS for depression.


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## azteca2 (Apr 8, 2016)

You might want to look into vagus nerve stimulation before ECT as it has few side effects. I've also read about interesting form of very precise brain stimulation called optogenetics that is being experimented on animals. And I don't know about you but I can feel emotion with thrill seeking behaviors like sex and certain recreational drugs. And not condoning this but many people with faulty reward systems seek out thrill seeking behavior whether it's bungee jumping, robbing a bank, hanging from the edge of a bridge. I'm sure I could feel emotion with risky behaviors like this. Last time I rode the a really scary ride at the fair I felt an adrenaline rush . Sports have also brought out emotion in me like when I was wrestling a friend due to not wanting to get beat .


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## TDX (Jul 12, 2014)

> Last time I rode the a really scary ride at the fair I felt an adrenaline rush .


I already tried this. I didn't feel anything, but all behavioural aspects of fear were present. There was absolutely no joy, like you normally would have.



> And I don't know about you but I can feel emotion with thrill seeking behaviors like sex and certain recreational drugs.


I tried masturbating, but I only feel the orgasm physically, but there is no pleasure.



> Sports have also brought out emotion in me like when I was wrestling a friend due to not wanting to get beat .


Sports doesn't work, too.


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## azteca2 (Apr 8, 2016)

Maybe u need need to push the limits with different thrill seeking behaviors. And masturbation really doesn't do much for me either. I want to try bungee jumping to see what that would do


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