A new therapy is providing hope for sufferers of extreme depression, writes Alex Wilde.
Until recently, suicidal thoughts were Teresa's* constant companion.
The 59-year-old designer from the northern beaches has always been creative, but the depression that crept insidiously through her mind for the best part of 30 years would make it impossible for her to concentrate on her work and enjoy simple pleasures such as walking the dog.
Thirty-year-old Catherine Baptiste has been clinically depressed for most of her life. The disease transformed the 30-year-old student from Parramatta from a bright, social person into a recluse who would lock herself in her room and sit in darkness.
For people like Teresa and Baptiste - whose depression has not remitted after trying several anti-depressants - electroconvulsive therapy (ECT) is often proposed as the next step. But late last year, both women took part in an alternative treatment being trialled at the Black Dog Institute, based at the Prince of Wales Hospital.
Known as repetitive transcranial magnetic stimulation (rTMS), the treatment stimulates the brain using strong magnetic fields, and has been showing success in people who are resistant to anti-depressant medication or who can't tolerate medication.
Trial leader Dr Colleen Loo, a research psychiatrist with the Black Dog Institute and senior lecturer at the University of New South Wales, say the treatment is non-invasive and has fewer cognitive side effects than ECT, which would give it a more acceptable public image.
"It is too early to say conclusively whether rTMS is going to be as effective as ECT. We are working on strategies to optimise the efficacy of rTMS and developing it to the point where it is clinically useful," she says.
The treatment is delivered via a simple butterfly-shaped coil held to the patient's head while magnetic pulses are directed for about 30 minutes to the left frontal lobe of the brain, which is thought to be underactive in those who suffer depression.
Loo says the patients suffer no memory loss from the therapy, which is a troublesome side effect of ECT.
ON THE RIGHT WAVELENGTH
Since 1997, about 70 people have received rTMS at the Black Dog Institute. Participants attend every weekday for a fortnight and receive either a placebo treatment or the magnetic pulses. Loo says the results are promising.
"After two weeks, it is hard to see differences, but other studies worldwide have shown rTMS to be more effective than a placebo," she says. "Following the two-week trial, everyone has the chance to receive active rTMS for up to six weeks, at no cost. Our data show that at least half of participants are getting better after six weeks of rTMS."
Not everybody responds to the treatment.
"Studies show that people who have a depression that is reactive to stress or people with a psychotic depression [depression accompanied by delusions, hallucinations] are less likely to do well with rTMS. But people who have a chemical kind of depression tend to be more responsive."
For Baptiste and Teresa, the treatment has meant they can get their lives back on track - for now. Baptiste writes poetry that is no longer sad or burdened, and she is looking at resuming her studies and starting an events company. "I can't wipe the smile off my face," she says.
Teresa's mood initially lifted, enabling her to return to her design business, but new stresses in her life have triggered further depression. "For the first time in decades, the suicidal thoughts have gone and my energy is back," she says. "But the treatment has only started me on the road to recovery and I am slipping back."
rTMS is being used in clinical settings in Canada and Israel, but Loo says that while the treatment has been researched in Australia for a decade, it is not available here as a routine therapy.
A lot of work remains to be done to find the best way to deliver the treatment.
"We are trialling studies that give rTMS twice a day instead of once a day, we are varying the number of pulses per second, varying which part of the head it is given to and trialling bilateral rTMS [delivery of pulses to both sides of the head]," says Loo.
rTMS has been studied only in adults, but this month the Black Dog Institute will break new ground by launching a four-week, placebo-controlled rTMS trial of 15- to 18-year-olds, making it the first research centre in Australia to evaluate the effectiveness of the treatment in adolescents. Given recent controversy over antidepressant medication for young people, an effective alternative treatment for depression in this age group would be most welcome.
The Black Dog Institute/University of NSW is recruiting participants for rTMS research trials. If you have been diagnosed with depression and would like to take part, contact Tara McFarquhar on 02 9382 3720 or email firstname.lastname@example.org