Magnet to cure depression?

[Lianad]

Just read this interesting article.. My first instinct was "must be woo"... But it appears they at least "attempted" a double blind study although some question the results. It does seem at least that they are working on running another more controlled experiment.

http://news.yahoo.com/s/ap/20081020/ap_on_he_me/med_healthbeat_depression_magnet;_ylt=AhMrUC.0gN7j C3qcVsygH4Gs0NUE

[paximperium]

Magnetic Convulsive Therapy has been used for years and is equivalent to Electro-convulsive Therapy for the use in depression. This seems to work on a different premise although we've been using various electrical brain stimulators for years especially for seizures etc. This looks interesting and hopefully the data will tell us if it works.

Unfortunately what we will see is woo-mongerers taking advantage of this and claiming their magnet X 2000 cures depression.

[calebprime]

One hopes this is better than ECT:

from the link

"TMS did prove to be very safe: Patients in the NeuroStar study suffered no seizures or memory problems like shock therapy can cause, or other reactions throughout the body. The chief complaint from the sessions was headaches."


Actually, ECT is a seizure.


eta: and I've heard people having had ECT who describe feeling like they've been hit by a bus. There's some confusion for a while.

[paximperium]

One hopes this is better than ECT:

from the link

"TMS did prove to be very safe: Patients in the NeuroStar study suffered no seizures or memory problems like shock therapy can cause, or other reactions throughout the body. The chief complaint from the sessions was headaches."


Actually, ECT is a seizure.


eta: and I've heard people having had ECT who describe feeling like they've been hit by a bus. There's some confusion for a while.

ECT is very good. It works and has minimal side-effects. Despite all the BS myths from movies like One flew over the cuckoo's nest, ECT is pretty painless.

Modern ECT is a controlled seizure. Patient's are anesthetized and received the pulse...the seizure lasts for at most 10seconds. The only side effect is lost of short term memory...no biggie since these procedures are done in the morning. The loss of morning and late night memories is worth the benefits of the procedure.

[Ivor the Engineer]

Are there any good theories as to why inducing seizures helps to relieve depression?

[Ivor the Engineer]

Magnetic stimulation has the advantage of not requiring contact with the skin, so there is little to no risk of burns.

[paximperium]

Are there any good theories as to why inducing seizures helps to relieve depression?

Here's a semi-decent review. It leaves out some newer studies but is good enough:
http://www.ect.org/cgi-bin/faq/smartfaq.cgi?answer=1014926800&id=1014926466

Spoiler: It is still not well understood.

[paximperium]

Magnetic stimulation has the advantage of not requiring contact with the skin, so there is little to no risk of burns.

Burns are rare but that's one of the primary advantage of a magnetic field. If I remember correctly, "aiming" it at the proper part of the brain is sometimes more difficult and is less effective for certain types of depression.

[Ivor the Engineer]

I think it's a wonderful example of how if something works we use it even if we don't have a clue as to why it works.

I'm pondering how ECT's effects on depression were discovered and which physician/scientist thought it was a good idea to zap depressed people's brains with several hundreds of volts!

And physicians wonder why some people don't trust them...

[paximperium]

I think it's a wonderful example of how if something works we use it even if we don't have a clue as to why it works.

I'm pondering how ECT's effects on depression were discovered and which physician/scientist thought it was a good idea to zap depressed people's brains with several hundreds of volts!

And physicians wonder why some people don't trust them...

Its an interesting story(I have an amateur interest in medical history). From memory, there was an eastern European doctor in the early 20th century who had patients with catatonic schizophrenia and seizures. The doc noticed that after each seizure, the patient's would be improved and no longer catatonic. I believe some data already showed that depressed patient's did better when in a coma or post-seizure.

Unfortunately(or fortunately?) they started to use a huge variety of techniques (many dangerous) to cause seizures in patient's with just about every mental illness(or even just personality quirks) you could think of. That was part of the reason that ECT has such a bad rep.

[calebprime]

ECT is very good. It works and has minimal side-effects. Despite all the BS myths from movies like One flew over the cuckoo's nest, ECT is pretty painless.

Modern ECT is a controlled seizure. Patient's are anesthetized and received the pulse...the seizure lasts for at most 10seconds. The only side effect is lost of short term memory...no biggie since these procedures are done in the morning. The loss of morning and late night memories is worth the benefits of the procedure.

The other reason is that it also causes some degree of long-term memory loss.

This is controversial. Here's a link to an advocacy organization (biased), but let's see if they have some studies. Here's one:

http://www.ect.org/electroconvulsive-therapy-causes-permanent-amnesia-and-cognitive-deficits/

Forbes
Electroconvulsive Therapy Causes Permanent Amnesia and Cognitive Deficits, Prominent Researcher Admits
12.21.06, 3:38 PM ET

NEW YORK, Dec. 21 /PRNewswire-USNewswire/ — In a stunning reversal, an article in the journal Neuropsychopharmacology in January 2007 by prominent researcher Harold Sackeim of Columbia University reveals that electroconvulsive therapy (ECT) causes permanent amnesia and permanent deficits in cognitive abilities, which affect individuals’ ability to function.

“[T]his study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings,” the study notes.

For the past 25 years, ECT patients were told by Sackeim, the nation’s top ECT researcher, that the controversial treatment doesn’t cause permanent amnesia and, in fact, improves memory and increases intelligence. Psychologist Sackeim also taught a generation of ECT practitioners that permanent amnesia from ECT is so rare that it could not be studied. He asserted that most people who said the treatment erased years of memory were mentally ill and thus not credible.

The National Institute of Mental Health (NIMH) estimates that more than 3 million people have received ECT over the past generation. “Those patients who reported permanent adverse effects on cognition have now had their experiences validated,” said Linda Andre, head of the Committee for Truth in Psychiatry, a national organization of ECT recipients...."


.....

cp here:



I discussed this with a highly regarded neurologist who teaches at Harvard, works at Mass. General, etc. She wasn't so cavalier as you are.

When I asked about it (not for myself but just generally) she made a face of real horror, and said that it definitely seems to cause some damage. Then she paused for a beat, and said that she'd also seen it work wonders on people with extremely severe depression. These are people whose depression is life-threatening.

Of course, it didn't do much to help Styron or David Foster Wallace, but this is just anecdotal. I shouldn't have brought them up here , except I use creative people with some brains to lose as my point of reference, not people with below-average intelligence.

Actually, the real cliche' is that people's concerns are based on One Flew Over the Cuckoo's Nest. FWIW, Kesey, at least, tried ECT for himself--he underwent the procedure just to see what it was like at the time. I'm not referring to the movie. I don't get my info from movies.

It's not clear how it works. One theory promoted by one psychiatrist was the "punishment" factor--I'll see if I can find who said this, and when--it was probably in the 50's or 60's.

Now, they tend to zap the right hemisphere only--so the brain can still talk, even if it has a less accurate idea of what it's talking about.

This is, by all accounts, a treatment of last resort.

Now, nothing is worse for your brain than killing yourself, so it has a rock-solid rationale.

Another point: Young brains are very plastic and resilient, and can recover from a great deal of damage. So people can and do go on from ECT to have normal lives--with or without some degree of cognitive deficit.

Life, after all, causes brain damage.

This is an interesting topic. Gotta run today.

Be back with studies tomorrow, perhaps.

[calebprime]

from the wiki:a

"Certain types of ECT have been shown to cause persistent memory loss,[7] whereas confusion usually clears within hours of treatment[citation needed]. Informed consent is a standard of modern electroconvulsive therapy[8]. Involuntary treatment is uncommon in countries that follow contemporary standards, but is becoming increasingly common in treatment of the elderly. Involuntary ECT is typically only used when the use of ECT is believed to be potentially life saving.[9]"

7 ^ a b Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M (January 2007). "The cognitive effects of electroconvulsive therapy in community settings". Neuropsychopharmacology 32 (1): 244–54. doi:10.1038/sj.npp.1301180. PMID 16936712


so, all we've got so far is this Sackeim...

You absolutely can't trust only self-reporting: One of the effects of brain-damage can be euphoria, after all.

[paximperium]

Great points Caleb. I'm about 5 years off my reading on this issue. ECT is still a treatment of last resort where all other medical modalities fail or an impending psychiatric life threat(Catatonic Depression for instance).

One wonders if this procedure is any less damaging than plain old epilepsy.

With this new data, perhaps we should be more careful. But one always weighs the benefits and dangers of any medical treatment.

[fls]

The other reason is that it also causes some degree of long-term memory loss.

This is controversial. Here's a link to an advocacy organization (biased), but let's see if they have some studies. Here's one:

http://www.ect.org/electroconvulsive-therapy-causes-permanent-amnesia-and-cognitive-deficits/

Here is the study.

http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf

Sine wave and bilateral electrode placement were associated with impairments that persisted to some extent at six months, while pulse and right-sided electrode placement were not. This provided additional support for the recommendation that ECT use pulse and right-sided electrode placement. Of course, "stunning reversal" and "face of real horror" constitute a better way to convey this sort of information.

Linda

[Jeff Corey]

Its an interesting story(I have an amateur interest in medical history). From memory, there was an eastern European doctor in the early 20th century who had patients with catatonic schizophrenia and seizures. The doc noticed that after each seizure, the patient's would be improved and no longer catatonic. I believe some data already showed that depressed patient's did better when in a coma or post-seizure.

Unfortunately(or fortunately?) they started to use a huge variety of techniques (many dangerous) to cause seizures in patient's with just about every mental illness(or even just personality quirks) you could think of. That was part of the reason that ECT has such a bad rep.

From healthyplace.com, this seems to agree with what I recall:
Shock treatment started in 1933, with insulin being used to drop the patient's blood sugar low enough to cause a coma and sometimes a convulsion. This was the idea of Manfred Sakel, who had been treating his private patients at the Lichterfelder sanitarium, near Berlin, in this manner for several years. Sakel's reasoning was the following:

My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells ... a reduction in the energy spending of the cell, that is in invoking a minor or greater hibernation in it, by blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the re-enforcement of the cell.

In just a few years after Sakel published his new method insulin shock treatment was being used on thousands of the world's mental patients. Today it is rarely used.

Laszlo von Meduna had a different theory, one he developed during the early 1930's while working at the Interacademic Brain Research Institute in Budapest. Meduna used a chemical (Metrazol), rather than the hormone insulin, to produce the convulsions. Like insulin, Metrazol was given by intravenous injection. Before the patient started to convulse, he or she experienced a horrible period of panic and impending doom, lasting up to a minute. It was not a popular treatment.

Ugo Cerletti, professor of neuropsychiatry at the University of Rome, conceived the method by which shock treatment is given today - electric shock. Cerletti accepted the idea that convulsions were good for schizophrenics and in 1938 started using electric shock to produce the convulsions. Electric shock treatment quickly replaced insulin and Metrazol as the favorite form of shock treatment,

[Ivor the Engineer]

So is it the rate of change which is important, or the intensity?

[Professor Yaffle]

Both my grandfather (bipolar disorder) and my great aunt (treatment resistant severe depression) had courses of ECT. I'm pretty sure it saved both their lives. I think my great aunt did have some memory problems afterwards, but considering that she was almost catatonic with depression without it, it was probably worth it. Neither of them had any regrets about having it.

I have always thought TMS looked really interesting too.

[Ivor the Engineer]

http://books.google.co.uk/books?id=rY43-wvZN_MC&pg=PA139&lpg=PA139&dq=ect+waveforms&source=web&ots=98RlpRd3gY&sig=KgzfqH1q0TDPfoZX4u-SfeTBLVc&hl=en&sa=X&oi=book_result&resnum=8&ct=result#PPA139,M1

Generally speaking, a less intense stimulus, in units of charge (milli-Coulomb [mC] or milli-Ampere-second [mA-sec]) or energy (joules or watt-second), is needed to produce a seizure with a brief pulse stimulus than a sine wave stimulus (Weiner 1980). This difference may be on the order of threefold. It is believed the leading edge of each phase of the waveform is responsible neuronal depolarization and seizure induction.

ETA: Futher down the page the authors basically say sine wave stimulation (i.e. plugging the patient into the mains) is not justified given the greater side-effects and lack of greater efficacy from this type of waveform.

[BenBurch]

I had heard that the origin of the electrical form of convulsive therapy came from anecdotal reports from electricians who had survived shocks and found that their depressive state eased markedly and for quite some time subsequent to the event.

[leon_heller]

Are there any good theories as to why inducing seizures helps to relieve depression?

Many years ago when I was studying psychology the theory was that the current discharge through the brain triggered the production of neurotransmitters like dopamine or redistributed them.

Leon

[Ivor the Engineer]

The bad news is you're going to fry in the electric chair tomorrow. The good news is this has been shown to be an effective treatment for depression, so at least you'll go out happy.

[Jeff Corey]

...It's not clear how it works. One theory promoted by one psychiatrist was the "punishment" factor--I'll see if I can find who said this, and when--it was probably in the 50's or 60's...
Actually, it was avoidance conditioning, a form of negative reinfocement, not punishment. Cotter gave ECT to patients at a South Vietnam mental hospital if they didn't work in the fields.
This was in the early days of "behavior modification", when untrained individuals did some pretty horrible things.
http://www.neurodiversity.com/library_cotter_1967.html

[calebprime]

Here is the study.

http://www.nature.com/npp/journal/v32/n1/pdf/1301180a.pdf

Sine wave and bilateral electrode placement were associated with impairments that persisted to some extent at six months, while pulse and right-sided electrode placement were not. This provided additional support for the recommendation that ECT use pulse and right-sided electrode placement. Of course, "stunning reversal" and "face of real horror" constitute a better way to convey this sort of information.

Linda

You're absolutely right. "Face of real horror" was an accurate description of her face, but not of the procedure.


I didn't ask her for a study, I just was curious what a working pro--who had treated William Styron and many other depressed people, and been depressed herself--thought about it, gut level.

I was telling an anecdote, and I admitted as much. Her facial expression and some words she used that I don't recall specifically conveyed an attitude. The attitude wasn't: "Rah, rah, this is great stuff. What a wonderful cure!" Instead, it was pure ambivalence. It was quite striking.

I'll try to e-mail her and see if she can find some other studies, or she can write something I can print here--though I probably can't use her name. But she'll be up on current research.

My hunch is that right-side brain damage is more subtle to pick up, because in right-handed people, this is not the verbal side, so much. People who have had massive right hemisphere strokes often deny the severity of their condition: A famous example is Woodrow Wilson. There are several stories in Oliver Sacks about such patients, as well.

I shouldn't mouth off when fls is around. Or ever.

[technoextreme]

I think it's a wonderful example of how if something works we use it even if we don't have a clue as to why it works.

I'm pondering how ECT's effects on depression were discovered and which physician/scientist thought it was a good idea to zap depressed people's brains with several hundreds of volts!

And physicians wonder why some people don't trust them...
God almighty you come up with so many absurd ways to rail against doctors.

[Ivor the Engineer]

God almighty you come up with so many absurd ways to rail against doctors.

Actually my comment was mostly a rail against practitioners of alternative medicine, but I felt I couldn't miss the opportunity to have a pop at regular physicians too. I'm sure their egos are big enough to take it.;)

[fls]

I shouldn't mouth off when fls is around. Or ever.

Oh, don't mind me. I dream about discussions that proceed without appeals to emotion, but in my saner moments, I realize that it is quite likely that they are necessary. :)

Linda

[Ivor the Engineer]

Oh, don't mind me. I dream about discussions that proceed without appeals to emotion, but in my saner moments, I realize that it is quite likely that they are necessary. :)

Linda

That someone seeks treatment for depression is an appeal to emotion, is it not?

[calebprime]

This just in:

What's JREF?
ECT is probably safer than meds in very elderly patients.
It can sometimes cause memory problems, but patients who are severely depressed
are often very happy to take that risk.
It can be remarkable to watch people rise from the depths as they get ECT.
Sorry for the staccato letter; my father is sick and I am busy with him and my
mother.
Hope you're well.
A

[Ivor the Engineer]

Has anyone proposed a synaptic theory of mental illness? I.e. Connections in the brain are what underlie conditions such as depression, rather than an imbalance of one or more neurotransmitters.

ETA: ...so ECT works by disturbing the connections which cause the illness.

[sol invictus]

Both my grandfather (bipolar disorder) and my great aunt (treatment resistant severe depression) had courses of ECT. I'm pretty sure it saved both their lives.

That's a very important comment. I think people tend to forget that depression is a lethal condition. Suicide is one of the leading causes of death, so if we assume suicides are caused by depression, depression must be one of the most deadly diseases around.

No one blinks when cancer patients are given chemo and radiation therapy that does major damage to their bodies, or when people are given drugs with severe side-effects for other dangerous medical conditions. So why is there such a reaction against ECT, which has very mild side-effects by comparison?

[Ivor the Engineer]

<snip>

No one blinks when cancer patients are given chemo and radiation therapy that does major damage to their bodies, or when people are given drugs with severe side-effects for other dangerous medical conditions. So why is there such a reaction against ECT, which has very mild side-effects by comparison?

Because in the past it was grossly misused and had much worse side-effects than it does now.

ETA: ECT was original performed without sedation or muscle relaxants. The patient was restrained and a block put in their mouth. It was not unknown for patients to spasm so violently that they broke their own bones. Then you have the memory loss and other cognitive impairments which often occurred. BTW, it does not appear to be just the inducing of a seizure will have the desired effect because the intensity of the current used is normally between 2 to 5 times above that required to induce a seizure.

[thesyntaxera]

I currently work in the Behavioral Health dept at the University of Iowa Hospitals. At this time there is an ongoing study being conducted on the potential uses of Magnetic Brain Stimulation. From what I understand it is not intended to be a replacement for ECT, it is more geared toward treating minor depression symptoms. The vast majority of depression sufferers take a small number of medications to manages their moods. I think the goal is to figure out a non-invasive way to do this that doesn't utilize medication as much if at all in the treatment process, and that doesn't involve running electricity through the body...something that impairs memory for the duration one is receiving ECT.

As far as ECT and TMS go...the principles are very similar...it is believed(and I paraphrase) that a depressed person is this way because their brain has evolved to be depressed...almost as if it is wired that way. By running electricity through the brain you damage some neurons, and you also shake up the biochemical reactions that are going on normally. If the normal reactions are ones that produce depressive symptoms then one should see a disruption of those symptoms after the procedure. TMS does this in a similar way by using magnetism to disrupt the brains normal bioelectrical activity producing a similar but less potent effect(no memory loss as far as I know), hence the emphasis a minor depression sufferers.

No, not woo, not by a long shot.

If you want to know more about this you could email these folks from our department-

TMS:
Ricardo Jorge M.D.
Chadi Calarge M.D.
Sergio Paradiso M.D
David Moser Phd

ECT:
Jerry L. Lewis M.D. (yes it's his real name)
Laurie McCormick M.D.

Their respective email addresses can be found here:
http://www.uihealthcare.com/depts/med/psychiatry/welcome/faculty.html