Neuroengineering meets neuroethics to address treatment-resistant depression

by

Dr. Maryam Shanechi. Cred­it: USC Viterbi

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Is This the Future of Men­tal Health? (USC Viter­bi School of Engineering):

“Brain–machine inter­faces (BMIs) pro­vide a direct path­way to the brain to trans­late brain sig­nals into actions … Below, Shanechi (Note: Maryam Shanechi, PhD, assis­tant pro­fes­sor of elec­tri­cal and com­put­er engi­neer­ing) answers some ques­tions about her work and what the future might hold for our under­stand­ing and treat­ment of men­tal disorders.

What poten­tial does this hold for the future not just of men­tal health, but of under­stand­ing our brains as a whole?

Neu­ropsy­chi­atric dis­or­ders are a major cause of dis­abil­i­ty world­wide with depres­sive dis­or­ders being the most dis­abling among them. About 30% of major depres­sion patients are treat­ment-resis­tant – that’s about 5 mil­lion peo­ple in the US alone. Hav­ing an alter­na­tive ther­a­py in the form of a BMI that selec­tive­ly tar­gets brain sig­nals that are the cause of emo­tion­al dys­func­tion can rev­o­lu­tion­ize treat­ment for neu­ropsy­chi­atric disorders.

But BMIs are not just a tool to cure men­tal dis­or­ders, they’re a tool for dis­cov­ery about men­tal health in gen­er­al. BMIs can help us bet­ter under­stand the neur­al mech­a­nisms of emo­tion reg­u­la­tion (how we start, stop, or change the tra­jec­to­ry of our emo­tions). One way to do this is to have par­tic­i­pants engage in emo­tion reg­u­la­tion while we mon­i­tor their brain sig­nals to study these fun­da­men­tal questions.

Brain regions pre­dic­tive of mood. Cred­it: Sani et al, Nature Biotech­nol­o­gy, USC Viterbi

Hav­ing a BMI that inter­acts with the brain might sound a lit­tle scary to some peo­ple. What are you doing to address to moral ques­tions that might arise from this kind of work?

First, we are design­ing these BMIs as alter­na­tive ther­a­py only for patients with very severe cas­es of depres­sion and anx­i­ety who do not respond to any oth­er ther­a­py. Sec­ond, of course, the eth­i­cal con­sid­er­a­tions for human BMIs are extra­or­di­nary and should be close­ly guid­ed by neu­ro-ethi­cists. But engi­neers have a role to play as well. Engi­neers of every dis­ci­pline are devel­op­ing all kinds of tools that are fun­da­men­tal­ly chang­ing soci­ety and the world as a whole. It’s impor­tant for all of us to approach our work, which we do for the good of every­one, from an eth­i­cal perspective.

BMI stud­ies in humans are no dif­fer­ent and should be per­formed with strict selec­tion cri­te­ria. There are already strict eth­i­cal stan­dards in place for epilep­sy patients, and this could be a good start­ing point for how to address future stud­ies on the human brain. As recent­ly stat­ed by Yuste and col­leagues, BMIs “must respect and pre­serve people’s pri­va­cy, iden­ti­ty, agency, and equality.”

Dr. Shanechi’s new paper:

Brain–machine inter­faces from motor to mood (per­spec­tive at Nature Neuroscience)

  • Abstract: Brain–machine inter­faces (BMIs) cre­ate closed-loop con­trol sys­tems that inter­act with the brain by record­ing and mod­u­lat­ing neur­al activ­i­ty and aim to restore lost func­tion, most com­mon­ly motor func­tion in par­a­lyzed patients. More­over, by pre­cise­ly manip­u­lat­ing the ele­ments with­in the con­trol loop, motor BMIs have emerged as new sci­en­tif­ic tools for inves­ti­gat­ing the neur­al mech­a­nisms under­ly­ing con­trol and learn­ing. Beyond motor BMIs, recent work high­lights the oppor­tu­ni­ty to devel­op closed-loop mood BMIs for restor­ing lost emo­tion­al func­tion in neu­ropsy­chi­atric dis­or­ders and for prob­ing the neur­al mech­a­nisms of emo­tion reg­u­la­tion. Here we review sig­nif­i­cant advances toward func­tion­al restora­tion and sci­en­tif­ic dis­cov­ery in motor BMIs that have been guid­ed by a closed-loop con­trol view. By focus­ing on this uni­fy­ing view of BMIs and review­ing recent work, we then pro­vide a per­spec­tive on how BMIs could extend to the neu­ropsy­chi­atric domain.

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