Until a few months ago, Jane Webber worried that she would have to endure electroconvulsive therapy for the rest of her life. The 59-year-old Colborne, Ont., resident had been suffering from bouts of severe depression for nearly 20 years, and when no medication seemed to help, her doctors resorted to the highly aggressive treatment to initiate seizures in her brain.
Electroconvulsive therapy (ECT), formerly known as electroshock therapy, worked for her; it helped to lift her out of her mental fog and crippling fatigue. But the twice-monthly sessions also left her feeling disoriented and gave her headaches, and she dreaded the idea of continuously subjecting her brain to such intense therapy.
In August, however, Webber’s doctors recommended that she become one of the first to test out a new, alternative form of treatment at Toronto’s Centre for Addiction and Mental Health called magnetic seizure therapy (MST). Instead of using electrical currents to create seizures throughout the entire brain, MST uses magnetic pulses to induce targeted seizures affecting an area about the size of a golf ball in the prefrontal cortex of the brain, thus avoiding the most serious cognitive side effects of ECT, namely memory loss.
So far, Webber has been responding exceptionally well to the new treatment. “I’m probably experiencing the best wellness I’ve had in a long, long time,” she says, noting that she feels mentally sharper and no longer disoriented after treatment sessions.
With the official opening of its new brain stimulation clinic Tuesday, CAMH is the first centre in Canada, and one of only a handful of facilities in the world, to offer magnetic seizure therapy. The clinic, dubbed the Temerty Centre for Therapeutic Brain Intervention and funded by a $7.4-million donation from the Temerty Family Foundation, is at the forefront of providing alternative treatments for depression and other mental illnesses, including schizophrenia and bipolar disorder – and it is aiming to conduct critical research in the process.
For decades, patients suffering from depression had limited treatment options: They had psychotherapy, drugs and, for those with “treatment resistance” to medication, ECT, explains psychiatrist Jeff Daskalakis, director of the clinic.
Now, patients at the Temerty Centre can be given a menu of increasingly invasive therapies. If medications fail to work, they may be offered repetitive transcranial magnetic stimulation, or rTMS, which also uses magnetic fields to stimulate focused areas of the brain. This is a gentler form of treatment than MST as it does not induce seizures but stimulates neurons to fire together, thus encouraging them to rewire.
Patients who do not respond to this treatment then move on to MST, and finally, if that does not work, to the full-brain seizure-inducing ECT.
Doctors have long been at a loss to explain why inducing seizures alleviates depression; they have known only that it does. But researchers believe that they are close to understanding how it works.
At the clinic, Daskalakis points to a strip of tickertape pinned to a wall showing the electroencephalography recording of a patient’s brain activity when seizures are induced during treatment. A series of sharp spikes mark the occurrence of the seizures, followed by a relatively straight line, indicating a suppression of brain activity. This suppression is caused by a neurotransmitter called GABA, which normally acts as an inhibitor, preventing excessive, extraneous and negative thoughts from flooding our brains, Daskalakis says. In patients with depression, GABA has been shown to be dysfunctional.
“So what we’re doing in ECT – and what we think we’re doing with ... MST, just more focally – is potentiating GABA to try to suppress this excessive brain activity and result in therapeutic improvement,” Daskalakis explains.
Besides severe depression, doctors at the clinic are also testing whether these brain-stimulation treatments can help patients with schizophrenia, bipolar depression or obsessive compulsive disorder.
They are also using the technology at their disposal to research and record activity in the brain, which could have groundbreaking consequences for how mental illnesses are diagnosed and treated.
Using electroencephalography and transcranial magnetic stimulation, they are able to examine changes in GABA and other brain activity in response to treatment, and to see how neurons are rewired, measuring the brain’s plasticity. Daskalakis hopes that recording and analyzing these changes will help researchers better understand how various treatments work, and eventually develop what are known as biomarkers to diagnose mental illnesses and gauge the efficacy of treatment.
While blood sugar, for example, is a basic biomarker for diagnosing diabetes, equivalent biomarkers do not yet exist when it comes to diagnosing mental illness.
“I have patients asking me, ‘Well, how do you know I have depression?’ or ‘How do you know I have schizophrenia? Is there an objective set of tests that lead me to demonstrate that fact?’ ” Daskalakis says. “That’s what we’re doing.”
Ultimately, he envisions being able to use this research to understand why some patients are resistant to certain forms of therapy and to predict how well they will respond to others. Eventually, he hopes, “we can tailor or personalize the treatment for individual people.”
James Temerty, director of the Temerty Family Foundation and founder of the green-energy company Northland Power Inc., says he is optimistic about the work the clinic will do. He has long held a personal interest in this field of mental-health research because his eldest daughter has bipolar disorder.
Over the years, he says, he has become fascinated with work involving the brain’s ability to change and rewire itself. “It was – no pun intended – a no-brainer” to donate the $7.4-million, he says. “I just had to do it.”
For patients like Webber, it is reassuring to know that other treatment options are available. “I can hope that … there will come a time when the depression will be put to bed for good,” she says. But even if she must live with the illness for the rest of her life, at least “it won’t be as scary,” she says.
ECT vs. MST
Both electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) cause seizures in the brain. As such, patients must go under a general anesthetic before treatment.
The biggest difference between the two treatments is how they are delivered. With ECT, electrical currents are spread across the skull and are conducted throughout the brain. Magnetic fields, on the other hand, can pass through the skull, targeting specific brain regions.
Consequently, ECT can disrupt patients’ memories, hampering their ability to learn new things, for example, or erasing their recollection of past events. Patients can also feel confused and disoriented for at least 30 to 40 minutes after awakening.
Because MST affects only targeted parts of the brain (mainly the prefrontal cortex, which is most associated with depression), it does not produce these side effects.
Patients show no memory loss and are alert and able to rattle off their names and birthdays correctly, and answer other orientation questions immediately upon waking. This makes MST a much less frightening and less daunting option.
The side effects of MST appear to be limited to those associated with the anesthesia, such as nausea and headaches.