Electromagnets provide rays of hope for people with depression
The Seattle Times: Electromagnets provide rays of hope for people with depression
By Nick Perry
Seattle Times staff reporter
Robert Miskimon’s list of treatments for depression reads like a clinician’s almanac.
During his first descent into darkness at age 17, doctors repeatedly injected him with enough insulin to induce a coma, then revived him with glucose, a once-popular treatment called insulin shock therapy. Later came psychotherapy. In the 1990s he tried new wonder drugs such as Prozac and Zoloft.
Each new treatment helped for a while, but then the benefits waned, said Miskimon, 61. The Vashon Island writer remains most enthusiastic about an experimental treatment he first tried two years ago: transcranial magnetic stimulation, or TMS. He said it immediately helped him sleep, eat and feel better.
“It’s the difference between feeling life is hopeless, pointless and futile to, for example, experiencing joy at the sight of an eagle outside my home or the thrill of my daughter doing very well at nursing school,” he said. “To be free from the pervasive gloom and darkness is a wonderful thing. It’s the freedom to have gradations of feelings.”
Transcranial magnetic stimulation uses powerful electromagnets to stimulate electricity inside the brain. What may sound like science fiction has gained respect in the scientific community, with several small studies showing beneficial results.
Now the National Institute of Mental Health has launched the most extensive study yet: a $7 million, four-year federally funded program to track 240 patients. The University of Washington is one of four sites tracking the patients, with the first of 60 due to begin treatment at Harborview Medical Center this month.
Although TMS has not been approved for use in the United States, it is being used in Canada. Should it eventually get the nod of the federal Food and Drug Administration, it would offer hope for thousands of patients who can’t tolerate antidepressant drugs or who don’t respond to them.
The roots of TMS can be traced to the 1930s, when a Hungarian psychiatrist first used electricity to jolt a patient’s brain into a seizure, a controversial procedure that became known as electric shock treatment. Now called electroconvulsive therapy, it remains an effective last resort for many severely depressed patients.
But the problem with inducing a seizure is that it often causes short-term memory loss and confusion. Proponents of TMS believe many patients could benefit from a gentler approach.
TMS typically involves a patient sitting in a chair for 30 to 40 minutes. A doctor rests a coil on the patient’s head, then turns on a powerful electromagnet.
The machinery sends 10 strong, short magnetic pulses every second to a particular point in the brain, stimulating electrical currents. Regular magnets, like those on your fridge, create a constant magnetic pull and won’t stimulate electricity in the same way.
One potential advantage of magnetism is that it effortlessly penetrates the skull, unlike the electrical approach which forces a current through skin and bone. During TMS treatments, patients typically feel little.
“You sit in a nice easy chair with a pad on your scalp and there is a little click and a little buzz and that’s it,” said Jim Kjeldsen, a 56-year-old journalist from near La Conner, Skagit County, who has tried experimental TMS. “It’s a bit of a problem sitting there for half an hour and staying awake.”
The magnet is usually focused on the left prefrontal cortex — a part of the brain thought to play a key role in controlling mood, and which studies show is often less active in people suffering depression.
What happens next is less clear.
According to Dr. Mark George, a pioneer of the treatment, the magnet stimulates or “tickles” the cortex, which in turn sends electric signals to the central limbic system, a more ancient part of the brain also associated with mood control.
George believes this increased electrical activity changes the brain’s chemistry, probably by increasing levels of neurotransmitters such as serotonin and dopamine. That helps elevate mood.
Other people theorize that the mental discord of depression may manifest in a physical way that is comparable to arrhythmia. That theory has TMS acting as a kind of pacemaker to better balance electrical activity, especially between the left and right sides of the brain.
But nobody really knows how TMS may work because scientists have yet to figure out all the intricacies of the brain.
A TMS patient typically gets one treatment per day, five days a week, for three to six weeks. Many proponents believe that an initial course of treatment can lift patients from a depressive episode and that later “maintenance” treatments can keep them from slipping back. That theory will be put to the test in the new study.
George, a psychiatry and neurology professor at the Medical University of South Carolina, began experimenting with TMS in the mid-1990s after finding inspiration while riding an elevator in a London research building. A bubbly man told him that a scientist just made his thumb jerk by putting a magnet against his head.
Noting the man’s animation, George wondered if magnets could be used to directly influence mood control. But the idea wasn’t embraced by the medical community, which had long accepted seizures as a vital part of any direct physical intervention in depression.
“When I began this a decade ago, these ideas were heretical,” George said. “Heretical and anathema.”
Years of failed therapies
Miskimon said he was at boarding school in 1961 when his first bout of depression struck. A good student, he became increasingly agitated and felt he was losing touch with his own body and the world around him. He all but stopped eating, losing 30 pounds and becoming emaciated. He was hospitalized for three months, regularly receiving the insulin-shock treatments.
In the years since, Miskimon tried different therapies and also turned to alcohol, which he hasn’t touched now for 20 years. Nothing worked long term. Miskimon learned to struggle through life with recurring bouts of depression, which seemed, he said, to arrive without warning and in no particular pattern.
Kjeldsen has also lived with depression since he was a teen. Particularly bad bouts seem to strike once every eight or nine years, he said.
“Not knowing if you will ever come out of this black hole is the worst thing about it,” Kjeldsen said. “It’s like a huge weight pressing down on you. You don’t get joy out of anything, and you have to map out every move all day long, because the automatic reflexes that keep you motivated are not there.”
Both Kjeldsen and Miskimon became patients in early TMS clinical trials overseen by Dr. David Avery, a UW professor and the director of inpatient psychiatry at Harborview Medical Center. Avery, another of the treatment’s pioneers, is overseeing the UW part of the new trial.
Kjeldsen said he was skeptical about TMS before the early trials but soon became a believer.
“At the end of the second treatment, I walked out of the building and everything looked a lot brighter, even the sky looked brighter,” he said.
He added that he’s not interested in trying electroconvulsive therapy (ECT), which he believes may cause some brain damage.
“It’s nothing I would like to do. I really like my brain cells, even though they play up,” he joked.
The new TMS trial is not only bigger, it is more nuanced than previous trials, which have administered a single, standard treatment. This time, patients will have their brain structure mapped so doctors can more accurately focus the magnetic pulses in the correct location. And the number of sessions a subject receives will depend on the response to each treatment.
Half the participants will be part of a control group receiving sham treatments — though later they will have the option of getting the real treatment.
Offered in Vancouver, B.C.
While transcranial magnetic stimulation is not approved in the U.S., one TMS device has been approved in Canada since 2002. A group called Mindcare Centres offers the treatment at clinics in Vancouver, B.C., and Toronto.
Iain Glass, Mindcare president and CEO, said the clinics have treated about 170 people. That includes about 60 from the Seattle area who make up a large slice of the Vancouver business.
A course at Mindcare typically involves 20 treatments spread over two weeks at a cost of $4,000 (U.S.). The treatment is not covered by most U.S. health insurers.
“We tend to treat really, really tough cases,” Glass said.
He said the average patient age is 48, and most have lived with depression since they were teenagers. Many have tried medication for years without much success, he said. People who try TMS tend to either respond “profoundly” or not at all, he added.
“It’s wildly exciting,” Glass said. “There are a lot of people for whom the system has failed, and we are giving them their lives back.”
Glass has big ambitions for the U.S. He said he wants to open 50 to 55 clinics here — if and when the FDA gives approval.
Until then, sufferers here will need to find other options. Miskimon said he will continue trying antidepressant drugs along with prayer and meditation.
“I think it would be a tremendous thing to be available,” Miskimon said of TMS. “I think of it as having the benefits of ECT without any of the drawbacks.”
“It’s a kinder, gentler approach to sanity.”
