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Studying the Ethics of Invasive Therapies for Depression

Depressed Woman

A Michigan State University College of Human Medicine researcher has received a $1.4 million National Institutes of Health-Brain Initiative grant to study the ethics around interventions that use electrical stimulation for treating depression.

Known as electroceutical therapies, many studies have verified the efficacy and safety of a broader group of these treatments called psychiatric electroceutical interventions, or PEIs. Yet, little research has investigated the ethical issues raised by the use of these often-invasive treatments.

“The goal is to ethically safeguard the use of these procedures by gathering data on the concerns that psychiatrists, patients and the general public have about using PEI to treat depression,” said Laura Cabrera, an assistant professor in the Center for Ethics and Humanities in the Life Sciences.

Eric Achtyes, a co-investigator on the project, explained that one of his patients had been depressed and suicidal for many years and ultimately decided to have electrical current passed through her brain, a procedure known as electroconvulsive therapy, or ECT.

The woman “made a full recovery, later telling us that it was the first time she had felt ‘normal’ since she was a child,” said Achtyes, an associate professor of psychiatry and director of the College of Human Medicine’s Division of Psychiatry and Behavioral Medicine.

Cabrera’s team will examine the ethical concerns around four PEIs including:

  • Electroconvulsive therapy, approved by the Food and Drug Administration for treating depression.
  • Transcranial magnetic stimulation, a non-invasive procedure, also approved by the FDA, which uses magnetic fields to stimulate nerve cells in the brain.
  • Deep brain stimulation, in which electrodes are implanted in the brain. This procedure also is used in treating Parkinson’s disease and other movement disorders, and several clinical trials are underway to study its safety and efficacy for psychiatric disorders, such as treatment-resistant depression.
  • Adaptive deep brain stimulation, a newer type of implant that automatically adjusts the electrical impulse to reduce side effects.

The four-year study will include national surveys of psychiatrists, patients and the public to measure their concerns.

“Electrical stimulation of the brain, while often effective, has a bad public image,” Cabrera said. “This is partly due to sensational depictions in popular books and movies.”

Additional researchers on the multi-disciplinary team include Robyn Bluhm, associate professor in the Department of Philosophy and Lyman Briggs College, as well as Aaron M. McCright, professor of sociology in the Department of Sociology. Achtyes will offer a practicing psychiatrist’s input.

McCright, who will design the survey questionnaires, said the multi-disciplinary approach is a primary strength of the project.

“We have experts from philosophy, ethics, psychiatry and social science,” he said. “The real world doesn’t fit into disciplinary boxes. The real world is complex.”

Bluhm agreed and added, “Essentially, we’ll be able to benefit from each other’s perspectives and learn from each other.”

  • Geri Kelley and Sarina Gleason via MSU Today

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