Norms set for surgeries to treat depression, OCD

MUMBAI: More than 50 years after surgery for mental illness fell into disrepute, guidelines have been drawn up for the first time to operate on patients with major depression and obsessive compulsive disorders (OCD). The World Society for Stereotactic & Functional Neurosurgery last month published guidelines to ensure that surgery is not misused against patients with psychiatric illnesses. The guidelines were published in the Journal of Neurology, Neurosurgery & Psychiatry. In the 1940s, American doctors performed thousands of surgeries—lobotomies—to 'cure' mental illnesses. The surgeries destroyed key areas in the brain that controlled emotions. "Lobotomies were crude and reduced a human being to animal-like existence," senior psychiatrist Dr Y C Janardhan Reddy from Bangalore's NIMHANS (National Institute of Mental Health and Neuro Sciences) said. Surgery was thereafter shunned for the longest time. "This was also the time that medicines slowly became available for psychiatric conditions," said Mumbai-based neurosurgeon Paresh Doshi, who was among 19 specialists across the world who drew up the guidelines. Surgery is still the last option for patients with mental illnesses such as depression or OCD. "In the last three years since we decided to perform functional neurosurgery, we evaluated 30 patients who came forward and only performed it on an Australian patient," said Dr Doshi. The operation was carried out at Jaslok Hospital in October. As per the new guidelines, surgery can be done only after clearance from the ethics committee of the hospital where it is to be done. "Prior to this, an independent three-member team of neurosurgeons and psychiatrists is needed to agree that the patient has no other medical option but surgery," said Dr Doshi. Dr Reddy said most institutes that offer surgery for mentally ill patients already follow the guidelines. "NIMHANS, for instance, set guidelines two years back that require a five-member team that is not involved in the treatment of the patient to study him/her," he said. According to him, operation can be the option only for severely ill, chronic patients who don't respond to medical treatment. "Five to 10% patients may need surgery. The idea of guidelines is only to prevent misuse," he said. Psychiatrist Dr Harish Shetty said guidelines should not stem from fear of violations. "However, selection of patients should be done stringently and involve specialists and the patient's family."   TOI