Depressed or manic?

02 October 2011

If you put an electrode into the brain of an extremely depressed patient, there is a risk that the procedure could lead to personality changes. On the other hand, the depression itself also causes changes to the sufferer’s personality. How can the risks best be balanced against the possibilities? These are topical issues for doctoral student in ethics Veronica Johansson, who works with LU’s Neuronano Research Centre.

Alongside the classic ‘armchair philosophy’, which can become quite abstract, there is also practical ethics which focuses on applied issues.

Veronica Johansson is unusually practical – she not only studies applied issues, she works at the heart of these issues. With one desk at the Neuronano Research Centre and one at the Centre for Theology and Religious Studies (CTR), she spends alternate weeks in each place.

“There are a lot of ethicists linked to different medical and engineering research groups, but their role is more one of an external consultant. It is very unusual to be such a clear part of a research group as I am”, she says.

The Neuronano Research Centre is an interdisciplinary research collaboration on brain implants – electrodes that stimulate or capture signals from different areas of the brain. One such method is called deep brain stimulation and is already used to treat Parkinson’s disease. However, today’s electrodes are over one millimetre thick and rigid, whereas the neuronano researchers hope to develop new electrodes that are both more beneficial and less damaging to the brain tissue. The more progress made in this direction, the greater the possibilities that the technology can also be used to treat depression, obsessive-compulsive disorder, epilepsy and other conditions.

Veronica Johansson is studying the ethical implications of this type of brain implant. She wants to work on issues in the here and now, unlike those colleagues who focus on more distant visions.

When it comes to the link between the human brain and modern electronics there are both plenty of scare stories and plenty of grandiose hopes: memory chips that are inserted into the brain and give a person new knowledge... consciousness downloaded to a computer as a ‘back-up’ copy, or transferred to a robot... the brain remote controlled by enemy forces, or improved via electronics that create new cyber humans...

“But all this is pure speculation without any scientific basis. However, there are still ethicists who devote all their time to considering this possible future, and research funding bodies that are fascinated by the visions and give grants to such studies”, says Veronica Johansson.

She has just finished an article for the journal Neuroethics, in which she claims that we should look beyond “blind optimism and unfounded fears”.

“There is actually an ethical dimension to which issues professional ethicists address. If you choose to put a lot of time into unlikely speculations about the future, there is less time left for more relevant current issues!”

So she studies the ethical issues related to brain implants for conditions including depression. This condition affects around 150 million patients worldwide, of whom more than ten per cent are not helped by current treatments.

The need for new treatment methods is therefore great and brain implants have produced good results in around half of the patients who have been studied so far. However, the studies have been small and, in order for progress to be made, large studies with many participants are now needed.
Such trials are in every interest of the patient group as a whole, but the question is what is in the individual patients’ interests. There are risks associated with both the surgery itself and with the implant, which could become dislodged or damaged. The brain stimulation can also produce serious side effects.

“Some Parkinson’s patients have gained better movement at the cost of a deterioration in speech. Some depression patients have developed a new, manic personality, so that they, for example, become oversexed or gamble away all their money”, explains Veronica Johansson.

There are many ethical dilemmas involved here. How can one explain the risks of an implant to a patient who sees this as a last chance to escape their illness‘ Which is better, to become manically uncontrollable or to remain in deep depression? And who decides what is best? The patient may enjoy having as much energy as a Duracell bunny, but his or her family may be suffering more than before. Is it then the patient, the family or the doctor who decides if and when the electricity to the implant should be switched off’

Veronica Johansson thinks that the trials of brain implants to treat depression should continue, but under extremely controlled conditions where the patients are carefully selected and where all side effects and sources of error are reported in detail.
“In the field of medicine everyone is interested in doing good. But the patient must not be exposed to unjustifiable risks and it is important not to be so fixed on a favourite hypothesis that its possible drawbacks are ignored”, she says.