A ‘shocking’ stigma
Magnets offer alternative for patients with major depression
DALLAS – Feb. 5, 2019 – Janice Blake was depressed and psychotic. She saw imaginary people in her food and wouldn’t eat. She believed an imposter was posing as her brother.
She was on the brink of committing suicide, a hopeless woman spiraling into the depths of her mental illness after the medications that had helped her cope for 26 years could no longer keep her sane.
Mrs. Blake’s family then offered her a choice in hopes of saving her life: get placed in a long-term mental health facility or undergo electroconvulsive therapy (ECT) at UT Southwestern’s Peter O’Donnell Jr. Brain Institute.
“I was afraid to try ECT,” said Mrs. Blake, 65, whose perception of the treatment involved patients being painfully shocked with electricity.
Yet Mrs. Blake reluctantly agreed, and quickly discovered ECT was nothing like the disturbing Hollywood depictions she had seen. After only a few treatments, her paranoia and depression dissipated, restoring the rational, smiling person her family feared would never return.
“It did save my life,” Mrs. Blake said. “It just brought me back to who I was a long time ago. Fun-loving, happy, and outgoing.”
Although the therapy can improve severe depression, ECT has been associated with temporary memory loss – a side effect that has contributed to its stigma and pushed UT Southwestern to test a new form of brain stimulation that may entice other patients to seek help.
The National Institute of Mental Health (NIMH) is funding a five-year clinical trial that expands on preliminary research indicating that an alternative brain stimulation method involving magnetic fields can ease depression without cognitive side effects. If proven effective, magnetic seizure therapy (MST) could usher in a new era of depression treatment that turns these therapies from a desperate last resort to an accepted, frontline option for severely depressed patients.
UT Southwestern is collaborating with the University of Toronto Centre for Addiction and Mental Health (CAMH) to enroll 260 patients with depression who will undergo either MST or ECT. The sites will document the antidepressant effects of both treatments and compare their impacts on cognitive function.
“Both ECT and MST treatments are very different than what we saw in ‘One Flew Over the Cuckoo’s Nest,’” said UT Southwestern’s Dr. Mustafa M. Husain, Principal Investigator for the U.S. portion of the trial, referring to the 1975 film that depicted a patient receiving violent seizures from shock therapy. “I hope, one day, MST will become an available treatment for our severely depressed, melancholic, catatonic, even acutely suicidal patients.”
‘The next evolution’
The evolution of electrotherapy spans the centuries – from ancient Egypt where people realized electric fish could be used to treat pain, to 1930s Rome where the first unmodified ECT treatment was given, to modern-day American institutes where ECT is utilized in the most severe depression cases.
By sending electric currents through the brain to initiate brief seizures, psychiatrists have documented strong yet unexplained success in reducing symptoms of major depression. But the potential for memory loss and decreased problem-solving abilities – which in most cases improve in the weeks following treatment – has discouraged ECT’s widespread use and spurred scientists to explore other methods of brain stimulation.
“Many patients are reluctant to try ECT because of the temporary cognitive side effects,” said Dr. Shawn McClintock of UT Southwestern, who is assisting in the clinical trial. “We need to find new antidepressant treatments to encourage more people to seek help.”
The solution might be MST, which is similar in application to ECT but utilizes magnetic fields instead of electric currents to induce the controlled seizures. Scientists believe that because the magnetic therapy creates a more focused seizure, it has fewer effects on cognition.
Previous findings have indicated that MST has antidepressant benefits in combination with being cognitively safe. But there has been relatively limited research on the technique, and UT Southwestern is the only center in the U.S. testing the technology through the clinical trial.
“I have seen some desperate patients over the last 20 to 30 years who weren’t being helped by their antidepressants but wouldn’t try ECT,” said Dr. Husain, Director of the Neuromodulation Research & Therapeutics Program at UT Southwestern. “MST may be the next evolution in brain stimulation for severe depression.”
‘Fight to the finish’
Mrs. Blake is sharing her story with the hope of saving lives. The startling narrative of her mental demise is a testament to her belief that everyone has a chance at recovery.
She had been a dedicated sister, wife, mother, and grandmother, but her roles in life buckled under the strain of her illness as her family desperately sought to save her.
“You see the fearfulness. You hear it in her voice. You hear her make remarks and tell stories that clearly never happened,” said Joe Pugh, Mrs. Blake’s brother.
He described the difficult time he had convincing his sister to seek help from UT Southwestern: “A fight to the finish,” he said. “We had to do some tough love.”
Mrs. Blake’s doctors say her case was complex initially due to a mix of depression, bipolar disorder, and some memory issues that had prompted her family to move her into a memory care unit before seeking help at UT Southwestern.
“She was a patient who was incredibly sick early on, so sick we were concerned about a neurocognitive disorder or a psychotic illness,” said Dr. Kala Bailey, Director of the Inpatient Psychiatry Unit at UT Southwestern’s Zale Lipshy University Hospital. “She looked like somebody who was developing dementia.”
‘Better way of life’
Similar to other patients treated with ECT, Mrs. Blake underwent a few treatments in her first week, then gradually lowered the number of visits over the next few weeks.
It wasn’t long before she was making plans to see her newest grandchild for the first time and attending family functions again.
“When you have a patient who has that kind of response, I find myself having difficulty wiping the smile off my face,” Dr. Bailey said. “It is amazing to see that kind of improvement.”
But for every Mrs. Blake, millions of others who could benefit from ECT or MST instead sift through various medications that have little effect. According to a major national study UT Southwestern led more than a decade ago, about two-thirds of depressed patients do not achieve full remission on their first antidepressant. A third of them have not achieved it by their fourth medication trial.
For Mrs. Blake, her personal story is proof that lifesaving help is available for those who can’t find relief through the pharmacy.
“There is a stigma out there,” she said. “The people who feel like they don’t have any help and don’t know where else to turn … I’m just trying to let them know that there is another way, a better way of life.”
About the trials
Dr. Husain, Professor of Psychiatry and Neurology & Neurotherapeutics and holder of the Lydia Bryant Test Distinguished Professorship in Psychiatric Research, is the principal investigator for the U.S. portion of the trial. Dr. Zafiris J. Daskalakis of University of Toronto’s CAMH is the Coordinating Principal Investigator.
Dr. McClintock is an Associate Professor of Psychiatry. Dr. Bailey is an Assistant Professor of Psychiatry.
The project is funded through NIMH, with equipment loaned through MagVenture.
For questions about trial participation, call the Neuromodulation Research and Therapeutics Program at (214) 648-2806.
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 15 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,500 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 3 million outpatient visits a year.