MRgFUS 3 Month Follow-Up

Yesterday, on a very snowy and icy day in Toronto, I had the three month follow-up appointments for the Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) that I had to help treat my depression.  It was a day filled with tests and meetings with doctors as they tried to see how I am doing three months after having my surgery.  From my point of view, my depression has been getting worse since my last follow-up appointment in December.  I have had very low mood and feelings of hopelessness and worthlessness.  Thus, I was not expecting much to come out of this day of testing and meetings.

The day started out with some psychiatric scales testing.  They do this testing at every follow-up appointment to see if my depression is improving or not.  In other words, to see if the surgery has been a success or not.  The testing primarily consisted of three scales to determine the severity of my depression.  As I wrote back when I originally did the psychiatric scales, all of the tests that I did at the time of my surgery showed that I was suffering from severe depression.  The first test that we did was the Hamilton Rating Scale for Depression (HAM-D).  Originally when I had my surgery, I received a score of 25 on this test.  In December, my score improved slightly to 24.  Yesterday, my score again improved slightly to 23.  Scores of greater than or equal to 23 indicate a very severe depression.  Thus, I have continued to score a slight improvement according to this test.  The second test that I did was the Montgomery–Åsberg Depression Rating Scale (MADRS).  Originally when I had my surgery, I received a score of 36 on this test.  In December, my score got worse to 38.  Yesterday, my score improved somewhat to a value of 34.  Scores of greater than 34 indicate severe depression.  So, I am getting slightly better according to this test, but still scoring in the level of severe depression.  Finally I did the Beck Depression Inventory (BDI).  Originally when I had my surgery, I received a score of 36 on this test.  In December, my score got worse slightly to a level of 37.  Yesterday, my score got even worse to a level of 40.  Scores of greater than or equal to 29 indicate severe depression.  Thus, I am getting slightly worse according to this test.  Overall, these test scores indicate that I am not improving greatly, but not getting substantially worse, which doesn't quite match how I am feeling as I felt my depression get worse.  Hence, the surgery has had no real effect on me as of yet, I am still suffering from severe depression.

Next I had an MRI performed to see what is happening with the lesions in my brain that were created as a result of the surgery.  At this point I am well beyond the time frame that they would be worried about severe neurological symptoms appearing.  However, they do want to take a look at the lesions as they can shrink as they heal.  When they are first created, they are swollen and quite large.  As time progresses, they begin to heal up and shrink.  They want to see how much they have shrunk and if they are still there.

Then I had a meeting with the neurologist for the research study in which I am taking part, Dr. Nir Lipsman.  The first comment that he had upon seeing me was that my hair had grown back.  I'm not sure what he was expecting, but it would be more worth mentioning if my hair hadn't grown back and I was still bald.  Anyway, he said that he had a chance to take a quick look at my MRI images, and, in fact, the lesions had decreased in size somewhat.  As I said this is to be expected and doesn't affect the probability of a successful outcome.  He reassured me that we are still early, only three months post-surgery, and that it can take up to a year to see any results.  Another thing that he said that was reassuring was that they viewed treatment-resistant depression as a separate condition from regular depression and that they do not view my surgery as a final attempt at getting better.  They view the surgery as simply the first attempt.  If the surgery does not work out, there are other things that they can try to cure me.  That made me feel better.

Finally, I had an appointment with the psychiatrist for the research study in which I am taking part, Dr. Anthony Levitt.  I mentioned to him that I had noticed my anxiety had somewhat improved (as I mentioned in a previous blog post), while my depression had gotten somewhat worse.  He said that this was a good sign.  It seems that the surgery works on a pathway in the brain that is primarily responsible for feelings of anxiety.  Thus, it is expected that my anxiety would get better first and that my mood would then follow.  That was a good thing to hear.  He also said that the surgery may make me more likely to have positive results from anti-depressant drugs that didn't work in the past.  He suggested four things for me and my psychiatrist to try to see if they improve my mood.  My psychiatrist and I were under the impression that we couldn't make any changes to my medications until at least six months post-surgery, but he said I am free to make changes any time we see fit.

Overall, it was kind of a mixed bag of results from this three month follow-up.  I am not improving, but that is not really expected yet, and some encouraging words from the study doctors.  I guess I just have to continue waiting and try some new medications to see if I get better.