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A brain implant that removes negative thoughts raises thorny ethical questions.

A team of scientists at the University of California-San Francisco has implanted a device in the brain of a woman who has been suffering from severe depression for a year. This case first demonstrates that highly targeted stimuli in a specific cerebral circuit, including brain patterns of depression, can be an effective form of treatment for severe depression, affecting 5% of adults worldwide. Is.

A study of the success of this treatment was published. October 4, 2021, The Problem of Nature Medicine., And has been hailed as an important moment. The intersection of neuroscience and a psychiatric disorder may pave the way for such treatments to become more common in the future, especially for those who have not been successful in pharmaceutical treatment.

“This study points to a new pattern that is desperately needed in psychology,” said Andrew Crystal, a professor of psychology and a PhD member at the UCSF Well Institute for Neurosciences. In a news release. “We have developed a health-related medical approach that has successfully treated our patient’s resistant depression by identifying and modulating circuits in his brain that are uniquely associated with his symptoms.”

In the past, researchers have failed in similar treatments using traditional deep brain stimulation (DBS). This is because most devices provide constant electrical stimulation in one area of ​​the brain. Historically, targeting different areas of people’s brains has been a major challenge for scientists. This specific pacemaker for the brain proved successful with Sarah, who discovered the neurobio marker only by its first name – a pattern of brain activity that senses the onset of symptoms – and investigative The team’s ability to customize a new DBS device to respond to this particular pattern.

“What we think is happening in this first patient is that something in the environment triggers a process that triggers a negative feeling, the onset of which worsens his depression.” Let’s take it before it becomes a major depression, “said Dr. Andrew Crystal, a UCSF psychologist and author of this article. “Our goal was not to make this patient happy. Our goal was to end his depression.”

The device immediately eliminated her depressive symptoms.

“We were able to provide this customized treatment to a patient with depression, and it reduced his symptoms,” said the lead author. Catherine Skangos., MD, PhD. “We haven’t been able to do this kind of personal therapy before.”

Before treatment, she was “at the end of the line,” Sarah said.

“I was very depressed,” he said. “I couldn’t see myself continuing if I was able to do all this, if I could never go beyond that. It wasn’t worth living.”

Although the treatment was personal to Sarah’s brain, scientists are hopeful that it is a smaller and more replicable treatment.

“There’s still a lot of work to be done,” Skangos said. And we need to see that an individual’s biomarker or brain circuitry changes over time as treatment continues. ”

Two more patients are on trial. Skangos hopes to add nine more eventually.

The idea of ​​changing one’s mood with an electric brain stimulus seems like the foundation of a science fiction plot, but it’s not new. Electroconvulsive therapy was introduced in the 1930s, and was developed in DBS, which seeks to introduce electrical pulses to a specific brain disorder at the right time. FDA approval for this particular treatment is still a long way off, but it sheds light on its possibilities in the future.

Still, the possibility of physicians combining and redirecting someone’s ideas, the use of electricity, leads to potential ethical difficulties for researchers and philosophical controversy for patients.

Frederick Gilbert, PhD, said, “With a closed-loop system you may not be able to experiment with any depressive phenomenology to target your depressive episodes when it is normal to experience the results, such as That funeral. ” In an email to Salon, senior lecturer in ethics at the University of Tasmania. “A system program that manages treatment when a specific biomarker is detected will not honestly capture some of the context. You are a free-thinking agent.”

Gilbert added that it could be misused – and that it raises new ethical questions.

“There are some possible degrees of misuse of neuro data that come out of the brain (some think that this neuro data may be our hidden and secret thoughts),” Gilbert said. “The possibility of biomarking neuronal activity with AI offers a possible introduction to the identification of a large range of future applications (such as aggressive blast prediction, addiction, etc.).”

For these reasons, Gilbert added, “at all costs” it is important to “keep human control in the loop”, both in the activation and control of one’s own neuro data.

Other philosophers differ. Laura Speaker Sullivan, an assistant professor of philosophy at Fordham University, told Salon that it is instructive to think about DBS devices, such as selective serotonin reuptake inhibitors (SSRIs), a general class of antidepressants that include Prozac. Including medicines.

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Most use of deep brain stimulation for severe depression such as mood disorders is going to work like SSRI or any other depressive treatment – where it is not forcing patients to think about a particular thing. “But it often relieves depression and depression,” said Speaker Sullivan.

Speaker Sullivan said deep brain stimulation was often the last resort.

“To qualify for deep mental stimulation, because it is invasive, you must have someone who is resistant to all other conservative or non-invasive forms of treatment,” he noted. “So there are a lot of safety precautions that can be taken to determine if a patient is a good candidate for deep brain stimulation.”

Speaker Sullivan, who works with researchers doing DBS research, said it is done with great responsibility.

“Appropriate consent, weighing the benefits and risks, and ensuring that patients and research subjects are aware of the benefits and risks,” said Speaker Sullivan. The person may not feel authentic. Speaker Sullivan said that this has also been a matter of concern with SSRI.

“The patient’s sense of self, or the kind of feeling of authenticity, to feel like himself, but it’s not unique to DBS. Mood, there can be a difference in quality.”

Speaker Sullivan added that she did not expect DBS to become a common treatment for mood disorders, meaning that its moral implications would not be a cause for widespread concern.

“I am troubled to see something that is going to spread widely in society,” said Speaker Sullivan. “I think of the conditions that are resistant to treatment, there’s a good chance we’re seeing more use of deep brain stimulation – it’s a tool that can take a step where pharmaceuticals Solutions don’t work. But it’s not going to be something that replaces pharmaceutical solutions, because they’re naturally less risky than surgical implants. ”

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