A Depression Switch?

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A Depression Switch?

continued

Mayberg knew all this from the literature and learned more in conversations with Lozano. She grew increasingly convinced that applying D.B.S. to Area 25 might control depression.

"So one day," she told me, "I went to Lozano and said: 'I want to turn off Area 25. Can we put a stimulator there and see if that does it?' And he goes, 'Why not?' "

Occasionally, Deanna felt good enough to go home. This feeling seldom lasted more than a few days. "You could tell she was getting bad again when she couldn't sleep," Gary said. "That was the red flag. She'd be around the house all night, watching TV, up worried, cleaning. Then she'd get worse each day. Her eyes got that sunken look. Those were the scariest times, when she was getting like that and I would drop the kids at school and go to work and know she was home alone."

During the bad periods, which was much of the time, Deanna thought about suicide almost constantly. Through the windows of the locked ward she could see Lake Ontario, cold and immense. While she was there, one patient managed to reach the lake, beyond the parking lot and a grove of trees, and drown himself. Deanna thought obsessively of doing the same.

"I imagined that all the time," she said. "That I would walk out there and walk into the lake and that would be it."

As the months and years passed and all treatments failed, it began to feel as if there were only one way out.

"It started to seem like, this is not going to stop," Gary said. "This is our life now. There were times I thought that it was going to end" — he looked across the table at Deanna — "only when you committed suicide."

"The worst part for me," Deanna said, "was not being able to feel anything for my children. To hug them, to have them hug me, and feel nothing. That was devastating. An awful, awful place to be."

The D.B.S. operation involves an intrusion that is delicate but brutal. The patients are kept awake so they can describe any changes, and the only drug administered is a local anesthetic. The surgical team shaves much of the patient's head and attaches to the skull, with four screws drilled through skin into bone, the stereotactic frame that will hold the head steady against the operating table and serve as a navigational aid. Mounting the frame takes only about 10 minutes. But because it involves driving screws into the skull ("You can't truly feel it," as one patient said, "but you can hear it and see it and smell it"), and because it leaves you with a steel frame around the head, many patients find this the most distressing part of the whole business.

Gary found the frame more than he could take. He kissed his wife and went elsewhere, hoping she wouldn't be a vegetable when he next saw her. Then Deanna was rolled to an M.R.I. machine, where scans would be taken; the scans would help guide Lozano in placing the electrodes.

During the hour or so while the computer processed the scans, Deanna chatted with Mayberg. The day before, she told Mayberg, on video, that what she most wanted was to hold her children and feel it.

When the scans were ready, she went to the operating room. She was placed on a table, which was tilted back like a La-Z-Boy. Lozano and his team bolted the stereotactic frame to the table, as it was described to me later. There was some scrubbing on her head, some chitchat among the surgical team, much fiddling with sterile drapes and instruments. Then Lozano fit a half-inch burred bit into a drill, turned it on and started drilling. He drilled right into the top of Deanna's skull, which brought a rattling sensation and a sound like that made by an air wrench removing the lugs off a car's wheel. Then he did it again.

Now Lozano threaded a guide tube — "It's a straight shot," he said later, "really quite easy" — down between crevices and seams to one side of Area 25, which is in two small lobes at the midline of the brain. He slid the first electrode and its lead down the tube, then repeated this for the other side. All this took nearly two hours. After he double-checked his locations, he wired the leads to a pacemaker and gave Mayberg a nod. They could turn it on anytime now.

Mayberg had squeezed into a spot at Deanna's side some time before. She had told Deanna that if anything felt different, she should say so. Mayberg wasn't going to tell her when the device was activated. "Don't try to decide what's important," Mayberg told her. "If your nose itches, I want to know." Now and then the two would chat. But so far Deanna hadn't said much.

"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' "

Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off.

"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'

"It was subtle like a brick," Mayberg told me. "There's no reason for her to say that. Zero. And all through those tapes I have of her, every time she's in the clinic beforehand, she always talks about this disconnect, this closeness and sense of affiliation she misses, that was so agonizingly painful for her to lose. And there it was. It was back in an instant."

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Deanna later described it in similar terms. "It was literally like a switch being turned on that had been held down for years," she said. "All of a sudden they hit the spot, and I feel so calm and so peaceful. It was overwhelming to be able to process emotion on somebody's face. I'd been numb to that for so long."

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Last updated: 4/06

A Depression Switch?

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