ECT vs. TMS. VNS vs. DBS. Huh? (Part Two)

I had no idea I was wading into a mysterious minefield of acronyms when I started comparing ECT and DBS last week.

All weekend, I mulled over this "charged" debate between Electroconvulsive “Shock” Therapy (ECT) versus Deep Brain Stimulation (DBS).

The more I thought about it, this more this “either/or” proposition bothered me.

CHARGED, CONTROVERSIAL, CONTENTIOUS

It's charged, all right. Very controversial and political. Consider the history of ECT.

Add all the agitprop Hollywood and other moviemakers have infused into the emotional discourse that swirls around ECT, morphing a psychiatric treatment into an instrument of cinematic horror – and no wonder ECT is so contentious.

Finally, a 20-minute phone-chat with my psychiatrist, Dr. Bob, cleared things up.

You'll see what I mean when I spell out the following acronyms of four approaches that all play a part in this "charged" debate.

ECT AND DBS AND VNS AND rTMS for TRD

ECT is Electroconvulsive "Shock" Therapy – for years it's been proven to work in many cases.
rTMS is repetitive Transcranial Magnetic Stimulation – similar to ECT, but less invasive, does not cause a seizure, but is still experimental.
VNS is Vagus Nerve Stimulation – newest of these procedures, surgical, not as invasive as DBS, but similar. Doesn't involve drilling holes into the brain. Not yet widely available.
DBS is Deep Brain Stimulation – most invasive surgical procedure, considered the last resort. ECT is a prerequisite. Still undergoing trials.

ECT, TMS, VNS and DBS all fall under the general category of Psychiatric Neuromodulation – procedures that use either electrical or magnetic currents on the brain to treat debilitating psychiatric conditions – mainly treatment resistant depression TMR – long term, chronic depression or constantly recurring depression which does not respond to standard treatments like medication or psychotherapy.

Dr. Bob explained that ECT and DBS are like apples and oranges. They don't compare as well as ECT vs. rTMS. And VNS vs. DBS.

NOBODY UNDERSTANDS WHY OR HOW "PSYCHIATRIC NEUROMODULATION" WORKS

Nobody really understands how and why these procedures work and the only one with any real track record is ECT.

Veteran CBC and CTV radio and television broadcaster Helen Hutchinson calls ECT her "ace-in-the-hole."

In 1994, after years of numbing, debilitating depression, and more than five years of psychotherapy, a series of antidepressants, four hospitalizations and two suicide attempts, Hutchinson agreed to try ECT. One course. Six treatments.

"I welcomed it when I finally decided to have it," she told me in January 1995, during a Toronto Sun interview. "After all, what can I lose – a few brain cells?"

After her first ECT treatment, "It was like the light went on, like a blind suddenly flapped open. Instead of being in a tunnel with just a tunnel at the end, I was released," she said.

Earlier this week, Hutchinson, now-73, sounded vibrant and excited to hear my voice after 13 years when she picked up her phone.

SHE NEEDED ONE COURSE. SIX TREATMENTS. NO MORE.

"I'm just fine," she said. That one course of ECT did the trick.

Hutchinson still sees her psychiatrist regularly, takes an antidepressant and knows if ever her depression threatens, ECT is available on an outpatient basis.

“That’s never been necessary,” she said.

For Deanna Cole-Benjamin, more than 80 ECT treatments did nothing for her devastating depression.

"For a short time, there seemed to be a glimmer of hope that it would work, but it never did," the Kingston, Ontario public health nurse said recently on the phone – happy to interrupt a quiet summer evening in her backyard with her husband and four children.

In April 2006, Cole-Benjamin, a public health nurse, now 44, was the subject of a riveting Sunday New York Times Magazine feature called A Depression Switch?

ECT IS A PREREQUISITE FOR DBS

Her depression seemed to come out of nowhere and for no reason in late 2000. Antidepressants were useless. Eventually, she had to stop working and was hospitalized for 10 months. Her depression proved completely resistant to all drugs, psychotherapy and all that ECT. For the next four years, she was in and out of hospital many times and often contemplated suicide.

In 2004, she was asked to participate in the first clinical trial of Deep Brain Stimulation, radical new brain surgery for treatment resistant depression. It was developed in Toronto by neurologist Dr. Helen Mayberg and her neurosurgeon collaborator Dr. Andres Lozano whose small DBS trial at the Toronto Western Hospital was recently published in the journal Biological Psychiatry.

"I feel very well," Cole-Benjamin told me.

The battery in the neurotransmitter in her chest (a pacemaker-like devise) needed to be replaced once, "but that's just day-surgery. Now I just go to Toronto periodically for check-ups," she said.

DBS – VERY, VERY INVASIVE SURGERY

“The initial surgery was very, very invasive," she recalls. It involved drilling holes into her skull and then deep inside her brain, so two electrodes could be inserted into Section 25, a procedure that has already been performed on 30,000 people with Parkinson's Disease.

She was awake during this two hour operation, under a local anaesthetic so she could report any changes she felt.

Today, Cole-Benjamin jokes about her brain bionics.

"My head's a little bumpy from all the electrodes," she said, laughing. "My hairdresser always says that – and when I'm travelling, I can't go through airport security scanners."

A small price to pay to have your life back.

 

Comments

[susan]

Good piece. I am glad it worked for Ms. Hutchinson. I too had 6 ECT treatments, and it was the biggest mistake I ever made in my adult life. But it always makes me feel happy to hear it worked for someone. We all want to feel better, and the things we do in that quest makes Arthur's Knights look like pikers.

I didn't know about DBS. I wouldn't consider it right now, but maybe if I ever needed it in future, at least I know about it.

Nice job Sandy.

[Sandy Naiman]

Hi Susan,

Thanks for your comment. I really appreciate it.

BTW, Vagus Nerve Stimulation is actually less invasive that DBS, but does precisely the same thing. You should consider that before DBS, if you're going to consider a surgical procedure at all.

The FDA has approved VNS for epilepsy and there are trials for it in treatment for depression, too. I'm not sure about VNS and DBS for bipolar, though. I have no idea how either of these treatments would work on the high side of things.

This is such a new field, and things are changing and developing all the time.

I sincerely hope you're managing to get some sleep.

Take care.
sln

[Sandy Naiman]

Susan, one more thought regarding your experience with ECT. As with anything else, there are vast variances in how it is administered. When I had my ECT treatments, back in the 1960s and 1970s, it was for psychosis. Not depression. The only drugs available were Haldol and Chlorpromazine, as I recall. I have never taken antidepressants.

Quite frankly, ECT was a benign experience for me when I had it. There were very few alternatives and the doctors essentially wrote me off, never expecting me to be anything more than a revolving door case. In those days, my diagnosis was schizophrenia.

I never had ECT after my diagnosis was changed to manic depression in 1975.

As with all treatments, they depend on the individual, the circumstance, the way in which a treatment is administered and the physician. With ECT these can vary, enormously, depending on where you are and when it was given. Every year, ECT is refined and improved. Still, no one really knows how it works or why. After 70 years!

Nothing is simple when it comes to the mind. I'm sorry your experience with ECT was so devastating for you, but I know it has worked for many people. I spoke to others, but chose to quote Helen because she is a media personality here in Canada and has advocated for ECT – a lone voice in the wilderness.

I wish you well in your quest to feel better.

Thank you, again, for your comment.

sln