Electrical stimulation improves depression
People with otherwise untreatable depression improved in a small clinical trial after receiving electrical stimulation of a part of the brain that scientists believe regulates sadness.
A report this week in the journal Biological Psychiatry said that 12 of 20 patients with chronic major depression benefited from the electronic device — including seven whose disease went into remission. The benefits were sustained over the course of the one-year study, researchers said.
“These were patients at the end of the road. They had tried other treatments, and nothing seemed to stick,” said University of Toronto neurosurgeon Andres M. Lozano, who led the study.
Major depressive disorder affects about 14 million people in the U.S., and 10 percent of them do not respond to standard medical treatment, according the study.
The nine men and 11 women studied had failed to improve after multiple medications, psychotherapy and electroconvulsive therapy, which is considered a last resort. Subjects had been taking an average of four medications when the trial began in 2003 and had suffered from major depression for an average of 6.9 years.
Deep brain stimulation is approved to treat essential tremors and Parkinson’s disease. Electrodes, which are permanently implanted in the brain, are powered by batteries and can be controlled by an external device.
Six patients showed such marked improvement that they were able to return to work after two to seven years of illness-based unemployment, according to the study, which was partly funded with a grant from the manufacturer of the device, Advanced Neuromodulation Systems Inc.
Researchers don’t know why eight patients failed to respond, Lozano said. A study of 150 to 200 patients is under way, he said.
Study: ER patients are often overloaded with information
Visits to an emergency room are confusing and nerve-racking events that one emergency room doctor describes as “usually the worst day of a person’s life.”
That makes for a poor setting for good communication. In a study published last week in the Annals of Emergency Medicine, researchers found that 78 percent of patients do not fully understand the care and discharge instructions they receive in the ER. Moreover, most people are unaware that they don’t understand what the doctor has said. One woman interviewed by the researchers immediately after her discharge could not name her condition (pelvic inflammatory disease) and misunderstood most of the instructions for home and follow-up care.
The problem, said principal investigator Kirsten Engel, of Northwestern University, is that doctors often deliver loads of complex information in a short amount of time. Patients are emotional and distracted, failing to listen carefully.
Engel said patients should take notes while in the ER, ask about anything they don’t understand, have a friend or relative present to help absorb information and read discharge instructions carefully. “Make sure you are an aggressive consumer of your health care,” she said. “You know you best. Ask questions. Challenge things that don’t make sense to you.”
A few things to know about myiasis
What is it? If you feel like your skin is crawling, you could have a case of myiasis. It occurs when fly maggots invade your body. Various forms of myiasis depend on the area affected — skin, body cavity, gastrointestinal tract, wound. In the United States, myiasis is primarily seen in people who have recently traveled to Central or South America or Africa. Cases acquired in North America are rare and primarily subdermal or ophthalmologic forms of the infestation.
Symptoms: These include a boil, painful swelling, necrosis, discharging wound, meningitis, visual disturbances, diarrhea and vomiting.
Treatments: Petroleum jelly or mineral oil can be used to force the maggots to the skin’s surface, where they can be extracted. Sometimes a local anesthetic and an incision may be necessary. The drug ivermectin, used in animals, has proven to be effective in humans.
Prevention: Practice adequate hygiene, keep all wounds clean and covered and don’t eat food that has been infected with fly larvae. When traveling to exotic places, use a repellent and a mosquito net.