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The neurologist refused. The patient finally gave in and went home in his median state with an agreement to return for regular checkups.

Maybe he found another doctor who was willing to make him happy. In , the American neurologist Helen Mayberg and the Canadian surgeon Andres Lozano published the first study of deep-brain stimulation for the treatment of severe chronic depression—the kind of depression that does not respond to anything: not medicine, not combinations of medicine and psychotherapy, not electric shock.

Yet six patients on whom everyone had given up suddenly got better.

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I pull them up out of a hole and bring them from minus 10 to zero, but from there the responsibility is their own. They wake up to their own lives and to the question: Who am I? Mayberg focused on a little area of the cerebral cortex with a gnarly name, the area subgenualis or Brodmann area It is located near the base of the brain almost exactly behind the eye sockets. Here, it is connected not only to other parts of the cortex, but to parts of the reward system and of the limbic system, brain regions involved with our motivation, our experience of fear, our learning abilities and memory, libido, regulation of sleep, appetite—everything that is affected when you are clinically depressed.

Morten L. Kringelbach

The patient was told that there were no particular expectations, and was asked to report everything she observed. The team began with their lowest-placed electrical contact. Nothing happened, even when they turned up the voltage.

Deep brain stimulation and the pleasure in the human brain

Then they went on to the next contact a half-millimeter higher in the tissue. She liked analogies and offered me one. Now, you can move. Mayberg related the story of a patient to me. This woman had an alcohol problem in the past and, after she had her electrodes installed, she went home and waited for them to give her a sense of intoxication or euphoria.

Pleasing Your Brain: An Interview with Dr. Kent Berridge » Brain World

She was completely paralyzed by her expectations, and Mayberg had to explain that there was nothing to wait for. The procedure had simply awakened the lady to the realities of her life.

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  • The symptoms of her disease were diminished, but she herself had to put something in their place if she wanted to fill her life. Ask any expert on addiction. You will wind up with people who demand more and more current. The journal Pain described such a case of dependence on deep-brain stimulation way back in In order to relieve insufferable chronic pain, a middle-aged American woman had a single electrode placed in a part of her thalamus on the right side.

    Anhedonia, the lack of pleasure, has been shown to be a critical feature of a range of neuropsychiatric disorders including MDD. Yet, it is currently measured primarily through subjective self-reports and as such has been difficult to submit to rigorous scientific analysis.

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    New insights from affective neuroscience hold considerable promise in improving our understanding of anhedonia and for providing useful objective behavioral measures to complement traditional self-report measures, potentially leading to better diagnoses and novel treatments. Reviewing the state-of-the-art of hedonia research and specifically the established mechanisms of wanting, liking, and learning, we propose to conceptualize anhedonia as impairments in some or all of these processes; thereby departing from the longstanding view of anhedonia as solely reduced subjective experience of pleasure.

    We discuss how deficits in each of the reward components can lead to different expressions, or subtypes, of anhedonia affording novel ways of measurement.

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    Specifically, we review evidence suggesting that patients suffering from depression and schizophrenia show impairments in wanting and learning, while some aspects of conscious liking seem surprisingly intact. We show how advances in whole-brain computational modelling can help stratify the heterogeneity of anhedonia across neuropsychiatric disorders, depending on which parts of the pleasure networks are most affected. This in turn has implications for diagnosis and treatment of anhedonia.