Something Old, Something New

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Brain Surgery to Cure Depression?
By Noah Evslin, Medical Researcher

If you watch our show closely, you know it's not the medical treatments that make Private Practice different than other shows on television; rather, it's the ethical debates our doctors have over any of the myriad decisions they need to make each week.

In this week's Episode 420, "Something Old, Something New," Naomi's senior citizen patient, MARION GORDON, is suffering from severe depression caused by the loss of a friend. This puts Naomi and Fife on opposite sides of the following dilemma:

Do you offer brain surgery—namely, a procedure called an anterior cingulotomy—as a way to cure chronic depression?

An anterior cingulotomy is a procedure where a doctor uses a gamma knife to destroy the parts of the brain that may be involved with depression. In most cases, the neurosurgeon targets the anterior cingulate cortex, which is the part of the limbic system that controls emotion.

By cutting lesions in the exact right locations, using an MRI scan to help pinpoint the correct areas to be cut, neurosurgeons have had some success in reducing depression in their patients. In fact, studies show that 32% of patients who consented to this type of treatment have shown significant reduction in symptoms of depression.

So, when Naomi and Fife go together to see Marion in her assisted-living environment, and she exhibits symptoms of severe depression, the ever-analytical Fife suggests this procedure as a possible cure for her depression. Naomi, on the other hand, is completely against the procedure. She can't believe Fife is suggesting that they go in and destroy a portion of a woman's brain because she's a little down. Amelia sides with Fife. She did the procedure early in her career and saw significant improvement in the life of her depressed patient. Surprisingly. Sheldon things surgery is the best option as well in this case, as talk therapy has a low success rate in elderly patients.

What does Marion think about all of this? She's dead set against it. She doesn't want surgery. She just wants to be left alone.

In the end, it's left unclear whether or not Marion has the procedure. She does open up to Fife about the loss of her friend, and opening up seems like a good first step in what looks like a long and arduous healing regimen.

Did Sheldon and Fife make the right decision in trying to convince Marion to have this dangerous procedure? Was Naomi correct in being so against it?

What would YOU do?