I Can See Clearly Now

I haven't posted an update to this blog since I had my DBS surgery almost 4 months ago.  There has been some substantial developments in that time, so I thought that I would update everyone about what has happened in that time.

On February 18th I had my DBS device activated.  The neurosurgery resident, Dr. Benjamin Davidson, turned it on.  The two electrodes going into my brain each have four contacts.  The two middle contacts are each in the target area of the brain and the first and fourth contacts are just outside of the target area, one on either side.  He activated the second deepest contact on each electrode, which is inside the target area, and set the voltage at 2.5 V.  He also gave me a controller that I can use to turn the DBS device on and off if I need to.  As you will see, it was good that I had it.

Then on March 10th I met with Dr. Peter Giacobbe, the psychiatrist of the study in which my surgery is a part of, and Dr. Davidson.  They decided to increase the voltage in my device from 2.5 V to 3 V, since I had no reaction thus far.  I felt nothing immediately, however the next morning my depression was even worse than it had been previously.  I couldn't get out of bed and I couldn't stop crying.  Since I had my controller, I decided to turn the device off.  As soon as I turned it off I could feel my mood begin to lift.  I met with Dr. Davidson on March 13 and he turned my device back on but activated the deepest contact, one which was just outside the target area.  He said that he activated that contact because it was closer to the grey matter.  I was cautious, but I went along with it.  He set the voltage at 2.5 V again.  I had no reaction.

On April 1st Dr. Davidson increased the voltage to 3 V.  Again I had no reaction.



On the morning of April 27th I again met with Dr. Davidson and he increased the voltage from 3 V to 4 V.  This time something incredible happened!  By the afternoon I was beginning to feel better.  This trend continued for the following week and has been continuing for the nearly 5 weeks since.  I couldn't believe the difference.  I was no longer continually telling my wife, Laila, that I was not doing well.  I stopped crying.  The black void in which I had been living my life had been lifted.  The only residual effects of my depression were a general lack of motivation, some fatigue and some low self confidence.  However things were substantially better than what they had been before.  I am hesitant to say that I have been cured, because anything can still happen, but things are going very well.  Dr. Giacobbe said the best indicator of how I will do long term is how I am doing after 3 months and 6 months, so there is real hope that things will continue to do well.  I feel better than the month of reprieve I got from my depression shortly after I had the Magnetic Resonance-guided Focussed Ultrasound Surgery (MRgFUS) a little over a year ago.  That makes me hopeful that this is a real change that will stick.

On May 25th I again met with Dr. Giacobbe and Dr. Davidson and they increased the voltage to 4.5 V to see if we could get rid of the lack of motivation, fatigue and lack of self confidence that were still there.  Even so, these effects are beginning to dissipate as I have been able to read eight and a half books in the last three weeks.  I can't remember the last book I was able to read before that.

As I said, I have been feeling really good, but the true test is how I do on the psychiatric scales that they regularly do on me as part of the study.  All of the tests that I did shortly before I had my DBS surgery showed that I was suffering from severe depression.  The first test is the Hamilton Rating Scale for Depression (HAM-D).  Before my DBS surgery I received a score of 25.  Scores of greater than or equal to 23 indicate a very severe depression.  On May 27th when I had this test, I received a score of 7, which is a normal result!  The second test that is the Montgomery–Åsberg Depression Rating Scale (MADRS).  Before I had my DBS surgery I received a score of 44.  Scores of greater than 34 indicate severe depression.  On May 27th I received a score of 8, which indicates mild depression, so I am doing very well according to this scale.  Finally there is the Beck Depression Inventory (BDI).  Before my DBS surgery I had a score of 41.  Scores of greater than or equal to 29 indicate severe depression.  On May 26th I had a score of 11 which indicates mild mood disturbance, so I am also doing very well according to this scale.

Overall, things are going well and I am glad that I had this surgery.  I just hope that they continue to improve and that I am able to get my life back.  As my psychiatrist tells me, getting your functioning back after having a prolonged depression takes a long time.  I may feel better, but it takes some work to rebuild my life and get back to the way that I used to be.  Hopefully things will continue to get better.