PEI project

Team Picture

Pictured left to right: Gerald Roman Nowak III, Aaron McCright, Robyn Bluhm, Laura Cabrera, Marissa Cortright, Emily Castillo, Eric Achtyes, Maryssa M.C. Gilbert.

 

Why the stigma? Watch a short video from the Michigan State University College of Human Medicine where I discuss studying the ethics of invasive therapies for depression. [March 2019]

 

About the Project

As part of this project I am leading an effort to identify the nature and frequency of ethical concerns, beliefs, and attitudes about four types of psychiatric electroceutical interventions (PEIs) among three key stakeholders groups: psychiatrists, patients, and healthy members of the public, including caregivers.

During the first year of the project, the team interviewed psychiatrists, patients and members of the broader public. This qualitative data, along with research already conducted by the team and by other scholars, guided the development of national surveys that where administered  to national samples of psychiatrists, patients, caregivers, and the general public. The survey contained questions to help the team determine how certain technological characteristics of PEIs (e.g., specificity, adjustability, risk/benefit ratio, and invasiveness) shape ethical concerns, beliefs, and attitudes among the different stakeholders.

We are currently working on classifying and comparing our quantitative and qualitative data across stakeholder groups and evaluate the ethical weight of the identified concerns and we are using those results to develop a comparative analytic map of ethical and social policy challenges to the broader implementation of PEIs in practice.

The significance of this work lies in anticipating potential future policy challenges in ways that will both effectively safeguard sustained ethical PEI development and translation, and benefit individuals affected by mental health disorders.

 

Technologies

is approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder that has not responded well to other types of therapies (aka, “treatment-resistant” depression). It is also FDA-approved for treating bipolar disorder. During ECT, which is often administered in general hospital psychiatric units and in psychiatric hospitals, patients are given a muscle relaxer and are then put to sleep under general anesthesia. An ECT-trained psychiatrist places electrodes on the patient’s scalp, and electrical current is used to initiate a seizure, which lasts for about a minute. This electrical current delivers the therapeutic effect. Patients usually receive ECT 2-3 times a week for a total of 9-18 treatments. ECT is estimated to produce substantial improvement in depression symptoms for 80% of patients. ECT is effective, but it is not a cure. Most patients usually need some kind of maintenance treatment (which may include ongoing ECT treatment, but may also be psychotherapy and/or medication). ECT works quicker than medications, and is useful for patients who are at a high risk of death due to suicide, failure to thrive, delirium, or catatonia. It is also useful for patients who cannot tolerate other treatments or for whom other treatments have not been effective. Side effects of ECT can include headache, muscle soreness, nausea, and short-term memory difficulties, all of which usually improve within a month of stopping ECT.

is approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder that has not responded well to other types of therapies (aka, “treatment-resistant” depression). It is also FDA-approved for treating pain associated with certain migraine headaches. During a TMS session, which is often administered in an outpatient setting, a TMS-certified physician places an electromagnetic coil against the patient’s scalp. This coil delivers repetitive magnetic pulses into areas of the brain associated with mood control, activating regions of the brain that have decreased activity in people with depression. Treatment sessions, which vary in length depending on the TMS coil used and the number of pulses delivered, typically last around 30-40 minutes. A typical course of TMS is done five times a week for 4-6 weeks. However, this can vary depending on an individual’s response to treatment. TMS requires neither surgery nor sedation, and it does not cause seizures. Maintenance treatment with TMS is not always necessary; however, if symptoms recur, TMS treatment can be repeated. TMS appears to be a relatively safe and reasonably well-tolerated treatment. Side effects of TMS are generally mild and include headaches, scalp discomfort, twitching of facial muscles, and lightheadness. Though rare, TMS has the potential for serious side effects including seizures, mania, and hearing loss. TMS is not recommended for people with any metal devices or objects implanted in their bodies.
has not yet been approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder. However, there currently are ongoing clinical trials to test whether it is effective for depression that has not responded well to other types of therapies (aka, “treatment-resistant” depression). DBS is FDA-approved for treating essential tremor, Parkinson’s disease, obsessive-compulsive disorder, and epilepsy. DBS involves the surgical implantation of electrodes into the brain by a neurosurgeon. These electrodes are connected to a small battery-powered device implanted under the skin of the upper chest. The device delivers electrical stimulation to the brain through the electrodes. DBS therapy may help restore normal activity in brain circuits that are not working properly, acting like a “pacemaker” for the brain. The amount and frequency of the stimulation are customized to the individual patient. Current evidence is inconclusive regarding the efficacy of DBS for depression. Potential side effects include bleeding in the brain, infection, stroke, disorientation or confusion, as well as complications due to hardware malfunction.
are a newer form of deep brain stimulation (DBS), have not yet been approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder. However, there is ongoing discussion regarding its potential use as a treatment for depression that has not responded well to other types of therapies. ABIs have been used for treating epilepsy and are currently undergoing clinical trials for treating Parkinson’s disease. Similar to DBS, the procedure involves the surgical implantation of electrodes in the brain by a neurosurgeon. These electrodes are connected to a small battery-powered device implanted under the skin of the upper chest. The device delivers electrical stimulation to the brain through the electrodes. Like traditional DBS, ABIs may help restore normal activity in brain circuits that are not working properly, acting like a “pacemaker” for the brain. Yet, unlike traditional DBS, which delivers constant stimulation to a part of the brain, ABIs vary the amount of stimulation they deliver in response to the patient’s brain activity. By automatically adjusting the electrical stimulation delivered, future ABIs have the potential to reduce side effects currently seen in DBS.

 

Recent Presentations:

  • Dr. Cabrera presented two talks as part of the 16th World Congress of Bioethics at Basel, Switzerland. She first presented as part of a symposium that she co-organized together with Dr. Judy Illes on social justice and neurotechnologies, a talk focus on perceived barriers towards PEIs based on the results from the National survey. Her second presentation focused on perceived ethical issues among psychiatrists, depressed patients. caregivers and general public towards PEIs, also based on results from the National survey.

Picture Panel

  • Undergraduate student Marissa Cortright presented research poster on “Psychiatric electroceutical interventions and their potential to influence personality: A cross-analysis of survey and interview results” at the Michigan State University Undergraduate Research and Arts Forum (UURAF), (April 2022)

 

  • We presented two research poster at the International Neuroethics Society.
    • Cross analysis of literature and clinical guidelines regarding psychiatric electroceutical interventions (PEIs) with practical concerns of psychiatrists.
    • Psychiatric electroceutical interventions and their potential to influence personality: A cross-analysis of survey and interview results. [Selected as top abstract by AJOB Neuroscience]

  • We presented a research highlight talk and poster at the 7th Annual BRAIN Initiative Investigators meeting entitled “Barriers & Other Ethical Concerns about Psychiatric Electroceutical Interventions for Treatment-Resistant Depression: A National Survey Study”

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  • Medical student Maryssa Gilbert presented trainee highlight award talk and poster at the 7th Annual BRAIN Initiative Investigators meeting entitled “Stakeholder Affect Toward Psychiatric Electroceutical Interventions for Treatment-Resistant Depression”

Gilbert poster PEI affect

  • Undergraduate Eleni Varelas presented trainee highlight award talk and poster at the 7th Annual BRAIN Initiative Investigators meeting entitled “Psychiatrists’ perspectives on clinical guidelines for use of electroceutical interventions in major depressive disorder.”

Poster9026_Eleni Varelas

  • Undergraduate student Marissa Cortright and Eleni Varelas presented research poster on “Mapping key ethical issues surrounding electroceutical treatments for depression” at the Michigan State University Undergraduate Research and Arts Forum (UURAF), (April 2021). **They won first place in the Health Sciences category**

 

  • Our poster “Comparison of perceived barriers regarding psychiatric electroceutical interventions as treatment for clinical depression” won 3rd place in the Research category at the Michigan Psychiatric Society annual meeting poster competition, April 2021.

 

Faculty Team Members

Laura Y. Cabrera, PhD – Associate Professor Neuroethics at Penn State.

Robyn Bluhm, PhD – Associate Professor Philosophy at Michigan State University.

Aaron McCright, PhD- Professor and Head of Sociology at Michigan state University.

Eric Achtyes (MD)- Associate Professor of Psychiatry and Director of the Division of Psychiatry and Behavioral Medicine at the Michigan State University College of Human Medicine.

Graduate Team Members

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Sandra Cai Chen (she/her/hers) is a Ph.D. candidate in the Department of Philosophy at Penn State. Her dissertation examines the role of emotions in care ethics and aims to develop an embodied understanding of them. Her main areas of research are ethics, phenomenology, and philosophy of mind. She has joined the team to join with the analytic map.

 

Undergraduate Team Members

Marissa Cortright (MSU)

Eren Sipahi (MSU)