New weapon in depression fight

Hey there, time traveller!
This article was published 23/09/2011 (5274 days ago), so information in it may no longer be current.

Tap tap tap, in quick succession: like a woodpecker. Like someone drumming their fingers on the side of the skull.

Each pulse, for some, can shine a light into the darkness of clinical depression — a light that may soon be in reach of Manitobans struggling with depression.

The treatment, which is called repetitive transcranial magnetic stimulation — rTMS, for short — doesn’t hurt, patients say. But it does wallop the wallet: One round of rTMS at a private clinic can cost up to $7,000. And that doesn’t include the price tag for travelling from Winnipeg to Vancouver, Toronto or Minneapolis for three weeks to get it done.

But soon, rTMS will be available free of charge in Manitoba, as the St. Boniface General Hospital Foundation heads into the final stretch of a $550,000 capital campaign to bring one of the coveted rTMS machines home.

The campaign will also cover the cost of a virtual-reality suite that will help patients, particularly adolescents, overcome anxiety and phobia disorders.

It’s the first time a hospital foundation in Manitoba has launched a major campaign targeted specifically at funding mental-health services. “The tacit response (was) ‘It’s about time,’ ” said foundation CEO Charles LaFlèche. “It’s amazing how it’s still a taboo topic, in terms of how many people are touched by mental illness.”

When it came time to open their wallets, those people came out of the woodwork. Since launching the campaign early this year, the foundation has collected over $450,000 toward its goal. About $80,000 came from mental-health physicians themselves.

Thanks to their donations, Manitoba will become one of the first provinces to make rTMS treatment available via the public system. “As a foundation you always want to differentiate yourself,” LaFlèche said. “It’s obviously a feather in our cap.”

Once the machine is up and running in a sunny spare room in St. Boniface Hospital’s McEwan Building, the Winnipeg Regional Health Authority will pick up the administrative and medical staffing costs. The hospital hopes to treat about 50 patients a year, focusing on patients who have had little success with medication or therapy.

Not all of those patients will see their symptoms improve. But the hospital will be watching. “This is exciting. I want to develop it — but on the other hand, it’s not a cure-all, not a panacea,” said Dr. Murray Enns, the WRHA’s director of adult mental-health services. “Our intent is to start with a modest number of people, and then do some careful evaluation… to build in from the beginning very careful measurements.”

The investment comes after about 10 years of accumulated evidence about rTMS’s efficacy — studies Enns watched with interest. “I’d been thinking about it for about three years, wondering when the moment (to invest in rTMS) would be right,” he said.

Especially compelling to Enns is the fact that unlike electroconvulsive therapy — which is still used as a depression treatment of last resort in some hospital settings — rTMS doesn’t cause memory loss, and patients don’t need to be anesthetized to endure it. “We’re always looking for that ‘something else,’ ” Enns said. “Where rTMS fits in is it’s an innovative treatment. If you do more of the same, you usually get the same result, whereas if you do a very different type of treatment, you get a different result.”

That difference has already quietly changed some Manitobans’ lives.

In August 2009, Sarah packed up and left her south Winnipeg home for three weeks, headed to Vancouver to receive the treatment. For 25 minutes, several times a day, she reclined in a medical chair while the practitioner at the MindCare Clinic sent the magnetic pulses coursing through her brain.

Sarah is not her real name. At 48, she has a bright career in health care; she worries that if colleagues and bosses learned of her lifelong battle with depression, she might lose her job. “It’s the dirty little secret you can’t tell people,” she said, sipping coffee on a suburban patio.

Few outside Sarah’s inner circle know the married mom has received rTMS treatment; but soon after her first treatment, those who know her noticed a change. Within the first week, the woman who has frequently had to push back against depression just to get out of bed was leaping up in the morning. Ready to go hiking, to go zip-lining, to do anything at all.

“I was very leery about, ‘Is this thing going to work,’ ” Sarah said of that first rTMS treatment, in the fall of 2009. “By about day five, I was feeling better but not really believing it. By day seven, my daughter said — ‘Mom, you’re like your regular self.’ “

Since starting rTMS, Sarah has cut her dose of prescription antidepressants by 75 per cent.

Sarah knows she is one of the lucky few: Her family can afford to spend thousands of dollars, once a year, on the treatment. But the promise of having access to rTMS in Manitoba, free of charge, is exhilarating. “I’m still not believing it yet,” Sarah said. “I have to see it to believe it.”

For some advocates in Manitoba, the foundation’s decision to invest in mental health isn’t just the promise of more treatment, closer to home — it also hints at fading prejudices. “Mental health,” Harriet Berkal said firmly, “is slowly being destigmatized.”

Last year, Berkal flew to Toronto to try rTMS. In the waiting room, she ran into someone she recognized; the woman pleaded with her not to tell anyone back home she was receiving the treatment. “I thought that was more tragic than anything I’ve ever heard,” Berkal said, shaking her head. “I’m infuriated by the fact that people feel that they have to hide their depression.”

So Berkal, an active community leader, makes no effort to hide her diagnosis; depression is a fact of biology, she said, no different than diabetes. She also doesn’t hide that her rTMS story hasn’t been quite as positive as others — after an initial round of euphoria, the benefits she received quickly plateaued.

That hasn’t dampened Berkal’s enthusiasm to see an rTMS machine in Manitoba. This year, she made it a personal mission to help raise the cash to complete the St. Boniface Hospital Foundation’s fundraising goal. “I’ve seen what it has done for other people,” Berkal said.

melissa.martin@freepress.mb.ca

A better way of treatment

The St. Boniface Hospital Foundation is in the last lap of a crucial fundraising campaign — its first targeted to raising money for mental-health services. The goal is to bring innovative rTMS treatment for depression and other mental-health conditions to Manitoba, free of charge.

 

What is repetitive transcranial magnetic stimulation?

It’s a relatively new treatment for major depression that sends magnetic pulses through the brain, a process that can ease symptoms of depression for many patients. There is also evidence that rTMS can help treat other conditions, including Parkinson’s, migraines and dystonia.

 

How does it work?

The details are still being studied. What we do know is that the magnetic pulses can cause long-term changes in how efficiently the brain’s neurons function, making them either more excitable, or more relaxed.

 

How does a patient receive treatment?

For about 25 minutes per session, a practitioner holds a coil near the patient’s skull. This coil produces a magnetic field that penetrates a shallow distance into the brain. The process is repeated up to three times a day for three weeks. Patients may go back to be “topped up” about once a year.

 

How effective is it?

Studies on rTMS are ongoing, but some have shown the treatment can work about as well as some classes of prescription antidepressants. And while other studies have found it less effective than electroconvulsive therapy, it appears to have significantly fewer side-effects.