Magnetic stimulation works by creating a small electric current in the left pre-frontal cortex, the area of the brain involved in mood, as well as planning for the future. The brain's memory centers, located in the temporal lobes, are spared any jolts. Because the magnetic field, unlike electricity, doesn't meet resistance from the scalp and skull, it's a very localized stimulation.
"Our research shows no confusion or decrease in memory function with magnetic stimulation," Avery says. "Seizures, the only significant side effect, occur in less than one patient in a thousand."
Avery is testing the promise of magnetic stimulation at Harborview Medical Center, where he serves as director of inpatient psychiatry. Avery's research began in 1996, and Harborview is the only site on the West Coast to be involved in a study of magnetic stimulation.
His study is open to those who have not responded to at least two antidepressant medications. While Avery doesn't expect magnetic stimulation to replace medication as a first-line treatment for depression, he feels that the new therapy offers hope to those who have failed on medication and are reluctant to try ECT.
Ten magnetic-stimulation treatments over a two-week period can be enough to produce a positive response. As is true for medication, the speed of response varies with each patient. Unlike ECT, magnetic stimulation requires no anesthesia or muscle relaxant, and patients are alert and coherent throughout the process. After 10 sessions, the patient then begins a medication regimen.
Depression affects between 7 and 17 percent of the population, according to the National Institute of Mental Health. It is a treatable illness, but people with depression are often reluctant to seek help because of the social stigma they feel is still attached to the diagnosis.
ECT, antidepressant medications and magnetic stimulation follow a long line of treatments, some of them helpful, others dubious, used to fight depression. Previous approaches include warm or cold baths, sleep deprivation, barbiturates, and such self-medications as opium, cocaine and alcohol.
The development of antidepressant medications started in the 1950s, when psychiatrists began to learn about the biology of depression. The medications that followed have made a big difference for sufferers of depression. Drugs such as Prozac and Paxil have helped many people with depression, and magnetic stimulation may enable more depressed patients to benefit from these medications.
"Depression is not just a sad mood," Avery explains. "Depression is associated with changes in basic biological processes. These may include such physical manifestations as unexplained pain, too much sleep or too little, or eating too much or too little. At its worst, depression can lead to hopelessness and suicide. Data indicate that 50 to 75 percent of people who commit suicide can be diagnosed as having suffered from clinical depression."
The willingness of public figures to acknowledge their own depressions has encouraged others to seek help, Avery says. Famous people who have suffered from depression include statesmen (Abraham Lincoln and Theodore Roosevelt) musicians (Robert Schumann), writers (Virginia Woolf, William Styron and Tennessee Williams), and actors (Patty Duke).
"Gifted people who have had ECT include Dick Cavett and Sylvia Plath, who was able to write brilliant poetry afterward," Avery says.
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