Alternative to ECT

I saw this in the local newspaper today.

Aug. 13, 2004. 07:24 AM

SIMON WILSON FOR THE TORONTO STAR
Dr. Gary Hasey, of the mood disorder program at Hamilton’s St. Joseph’s hospital, treats Klaus Schmidt for his bipolar mood disorder with a Transcranial Magnetic Stimulation device.

Mood disorders respond to new therapy
Magnetic pulses affect brain
Fewer side effects than electroshock

For 15 years Klaus Schmidt's life was in shambles.

The 61-year-old St. Catharines man says he "lost everything" after he developed bipolar mood disorder. Despite trying several different medications and numerous rounds of electroshock therapy, nothing seemed to stabilize his wild and debilitating mood swings. At one point, he was so despondent, he tried to kill himself.

The once hardworking and dedicated businessman was forced to go on long-term disability. He voluntarily gave up his driver's licence after he had been in several car accidents when the illness overwhelmed him.

"You cannot know what it is like unless you have (been there)," he says. "People say that they understand and they try, but it is like living in hell."

Then Schmidt learned of a new approach available in Hamilton that showed good results with hard-to-treat (or treatment-resistant) cases like his own.

The therapy — called repetitive Transcranial Magnetic Stimulation or rTMS — uses pulsed magnetic fields to alter the brain's chemistry.

Numerous research studies over the past 10 years have shown the treatment can help depression and stabilize mood swings as effectively as electroshock therapy (known as ECT) without the discomfort, memory loss and seizures that are part and parcel of that treatment.

Unlike ECT, there is no need for a general anesthetic during rTMS. And because the magnetic pulses target a small, yet specific, brain region, the procedure does not cause seizures or any major side effects, research shows. The only commonly reported after-effect is a headache, experienced after treatment by 10 to 20 per cent of patients.

Though he was skeptical. Schmidt was ready to try anything to avoid ECT. Working with Dr. Gary Hasey of the mood disorders program at St. Joseph's hospital in Hamilton, he started therapy with rTMS.

Within a few weeks, Schmidt says, he "was a new man. I could not believe it ... it worked and there was nothing scary about it," he says. "You don't have anesthetic and really feel nothing. But it has changed my life. I have hope."

The treatment was developed in 1985 and has been refined as ongoing research has explored how to use it safely and effectively. It works based on principles similar to regular MRI scans, but rTMS uses different frequencies of magnetic pulses aimed at a small area — about the size of a toonie — in the brain's prefrontal cortex. Researchers have long believed this part of the brain regulates mood.

However, though researchers knew rTMS could be highly effective for some patients, getting lasting results was a challenge.

Studies were conducted with pulses of different frequencies. Some targeted the left or right side of the brain and others both sides.

Health Canada has approved various makes of the device since the mid-1990s. This spring, a firm called Mindcare Centres, opened a private clinic in Toronto treating people for $3,000 to $6,000, depending on whether the patient needs maintenance sessions.

Iain Glass, president of Mindcare Centres, says the new clinic in Toronto, and one that opened in Vancouver two years ago, have treated about 100 people to date — with the majority showing significant improvement. Clinic treatments last about half an hour.

Dan Strasbourg, spokesperson for the Ontario health ministry, says repetitive Transcranial Magnetic Stimulation has been reviewed by the Ontario Health Technology Advisory Committee and its recommendations to the ministry will be posted on the committee's website on Wednesday. The committee will recommend whether rTMS should be used, where and when, and if government resources will be spent on it.

Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's College Health Sciences Centre, hopes to bring the therapy to his hospital should the government review permit. He believes it is based on sound, evidence-based medicine.

Levitt says if you imagine depression as caused by an over-excited brain chemistry, rTMS targets the part of the brain that helps co-ordinate brain chemistry so it can work normally.

If the health ministry approves the device for use in Ontario hospitals, "it will provide an excellent alternative to ECT in some people," he says.

Despite the initial price tag, Levitt says he thinks rTMS may turn out to be more cost-effective than ECT. believes. In addition, "it is less invasive and safer."

But some doctors think the device is not ready for clinical use. Hasey, who treated Schmidt, has been researching rTMS in Hamilton since 1997. Though the therapy has promise, it will take at least five years of continued refinements before it is ready for clinical use, he feels.

His work shows the procedure works very well in 30 per cent of cases, with another 20 to 30 per cent of patients showing improvement.

Since individuals' physiology varies so much, researchers still can't reliably target the correct brain site, he says. "If they are off by a few centimetres, maybe the patient doesn't respond. But it's not due to the treatment, it is due to where they are applying it," he says.

To establish a threshold for what type of pulse should be used and where it should be applied, doctors first find the part of the brain that must be stimulated to evoke motor movement in the thumb. Once that region is located, an area about five to six centimetres away is targeted with rTMS to affect mood.

Patients are referred by their doctor or psychiatrist. At Mindcare Centres, a patient undergoes the therapy five days a week, for three weeks. The 30-minute session is aimed at the left side of the brain and patients wear earplugs to dampen the clicking noise from the device.

Most show improvement within one to two weeks, Glass says. They are followed up at four- to six-week intervals after their sessions to see if they need maintenance therapy.

The best candidates for the treatment are younger patients and those without psychotic depression, studies show. Over the years that rTMS has been researched, people with a history of seizures or who have close relatives with seizure disorders have been excluded as have those with pacemakers, certain heart conditions or ferromagnetic items implanted in their skull.

Mindcare Centres reviews all potential patients on a case-by-case basis and does not automatically exclude specific patients. The firm says rTMS is cost-effective and estimates each patient effectively treated saves at least $10,000 in drug costs and lost productivity and wages. Three of the major insurers in Canada are now funding the therapy, Glass says, and several employers also covered it for their workers.

Hasey is conducting research that he says may indicate people who respond to rTMS have different brain wave patterns than people who do not. His clinic in Hamilton is conducting studies of rTMS for depression and bipolar disorder and is looking for volunteers.

Though Hasey believes the treatment is safe, he thinks it needs to be used in larger trials to make sure. "Remember, back years ago they'd use x-rays on your foot to fit your shoes at the shoe store," he says. "Back then, they thought that was safe. We still have a ways to go before we can use rTMS outside of a hospital setting."

But with depression cited by United Nations agencies as the second leading cause of death and disability in the world, the pressure is on for better approaches.

Levitt says the newer class of antidepressants, known as SSRIs, have many advantages over older antidepressants and are effective in up to 70 per cent of people with depression. However, they may cause significant side effects, including sexual problems, he says. Recently they have been linked to suicidal thoughts, which Levitt calls "rare."

He is confident rTMS will be in use within a few years. Besides treating depression, it has shown promise in diseases such as Parkinson's, schizophrenia, anxiety disorders and obsessive-compulsive disorder.

Schmidt says there are many people like him who do not respond to medication or ECT. "It is wrong to keep it from them," he says.

"It will give hope to so many in the future."

Additional articles by Robin Harvey

Very interesting. I am sure this is from the research recently written about regarding MRIs and depression alleviation... they is much research about magnetic waves and our bodies... alignments and such... but then, there has always been books about chakras and zones. I'm glad the medical science is trying to catch up!

Thanks for your input.

Yep. Me too. The less intrusive, the better. The cost right now really hurts the bank account, but hopefully the government will be able to help out. Also having insurance coverage would be good too.

hmmm beginning to wonder about how good having insurance is....

Yeah, only if they're good, and you dont pay much premium.

Thank you for posting the article. Alternative treatments appeal to me much more and I believe they're more effective in the long run. You know, 3 thousand dollars is 9 thousand Brazilian moneys. It should buy years of therapy and health insurance. You guys are so lucky to live in countries where you can expect the government to help, as well.
Good luck, everybody.

You're welcome. saudade. I'm kind of sitting on both sides of the fence right now. I'm a little sick and tired of taking so many medications because I have a few physical and mental illnesses.

Having something else that can help will be great, but I wonder how well these new method works. I guess lots more research will have to be done.

I don't expect the government will run with this. They're very slow on some issues....

Good luck to you too. )