Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression
Thomas E Schlaepfer1,2, Michael X Cohen3,4, Caroline Frick1, Markus Kosel1, Daniela Brodesser1, Nikolai Axmacher3, Alexius Young Joe5, Martina Kreft1, Doris Lenartz6 and Volker Sturm

“Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia—the inability to experience pleasure from previously pleasurable activities—and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto–striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward system—in which the nucleus accumbens is a key structure—are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression.”
Perhaps I don’t need a brain transplant-a little deep brain stimulation may do the trick!   Diane

I believe most definitions of depression don’t do it justice.  For me it is a pervasive psychic pain, so inhumane that at its worse, I curl up into a tight ball to escape it, but there is no contraction powerful enough to crush it.  Fortunately, I spend only about 3% of my time there, although at some points in my life it has been much more.  Approximately, another 15% of the time the pain mixes so intimately with anxiety, I can’t stop moving, but I can’t accomplish anything either. I can’t sit down I can’t focus, it’s as though my psyche has jumped up and is trying to escape the pain by running and hiding from it inside myself.  As you can see it’s totally an inside job.  At some point I will reach the shuffling stage, where I drag myself around trying to fix everything, on the exterior, I believe is deteriorating or out of control, another 15% of the possibility of enjoying life -vanished.  After a cycle of this or some combination anhedonia is a relief, although it holds no joy or comfort.  It is a step up out of the morass, where I can turn back into the robotic producer of results, provider of services, caretaker, organizer, teacher, all those things that make me look “normal” most of the time.  Normal, take a shower, put on my makeup, dressed up and smile-as normal as I get, but not very rewarding.  Who lives to look good?  At this point, I guess I do, about 65% of the time.  So, if you’re adding we’ve covered 98% of the terrain of my life.  Of course, if that’s all there was, I would only have a depressive type diagnosis, however, my behavior the other 2% of the time, has earned me a bipolar diagnosis. That’s when I’m energized, alarmingly social and behaving in a manner that would shock my mother, to say the least.  In fact, I’ve been known to shock myself.  Although I put myself in some extremely dangerous situations, during these forays into the other world, it’s the anhedonia that’s killing me. Overdosing on nothingness with no hope of escape. More meds please.  Diane

I love technical info:

Acute stress reduces reward
responsiveness: implications for depression
by
Bogdan R, Pizzagalli DA.
Department of Psychology,
Harvard University,
33 Kirkland Street, Cambridge,
MA 02138, USA.
Biol Psychiatry. 2006 Nov 15;60(10):1147-54. ABSTRACT

“BACKGROUND: Stress, one of the strongest risk factors for depression, has been linked to “anhedonic” behavior and dysfunctional reward-related neural circuitry in preclinical models. METHODS: To test if acute stress reduces reward responsiveness (i.e., the ability to modulate behavior as a function of past reward), a signal-detection task coupled with a differential reinforcement schedule was utilized. Eighty female participants completed the task under both a stress condition, either threat-of-shock (n = 38) or negative performance feedback (n = 42), and a no-stress condition. RESULTS: Stress increased negative affect and anxiety. As hypothesized based on preclinical findings, stress, particularly the threat-of-shock condition, impaired reward responsiveness. Regression analyses indicate that self-report measures of anhedonia predicted stress-induced hedonic deficits even after controlling for anxiety symptoms. CONCLUSIONS: These findings indicate that acute stress reduces reward responsiveness, particularly in individuals with anhedonic symptoms. Stress-induced hedonic deficit is a promising candidate mechanism linking stressful experiences to depression.  http://www.biopsychiatry.com/anhedonia.htm  “If you would just beat the crap out of the ___ who is threatening to shock you, depression would be unnecessary!   Diane