Shock and Awe

The stunning comeback of electroshock and other harrowing treatments for the mentally ill

Throughout those early years of her depression, Kelley was able to hold down a job in downtown DC working as the publications director for a trade association. But when that became unmanageable, she began working from home as an independent contractor, where her insomnia and bizarre sleeping habits would go unnoticed by clients. After several years, the depression obliterated her ability to concentrate and Kelley quit working altogether. She went on Social Security disability in 1998.

Deb, an elementary-school teacher, got into the habit of calling home four times daily just to make sure Kelley was still there, still alive. She would arrive home each evening with her heart in her throat, afraid of what she would find on the other side of the door.

After exhausting a long list of antidepressant medications, Kelley began "volunteer work" as a pharmaceutical lab rat, hoping that some experimental drug might ease her depression. She started off close to home, at a drug trial at the National Institute of Mental Health (part of the National Institutes of Health) in Bethesda, Maryland. After a doctor there refused to let her go home one day, afraid that Kelley would harm herself, she was referred to an experimental treatment that was supposed to be a kinder, gentler form of electroconvulsive therapy.

While ECT runs electricity broadly across the brain and induces a seizure, this newer treatment, called transcranial magnetic stimulation (or TMS), uses magnetic fields that induce much weaker, more focused electric currents directly to the area of the brain responsible for mood regulation (called the left prefrontal cortex). It's much more focused than ECT, doesn't cause seizures, and doesn't require anesthesia, so the process is considerably less intimidating.

Before receiving TMS, Kelley underwent a series of brain-imaging scans that were used to pinpoint the specific area to be targeted. She was injected with radioactive fluid to "light up" her brain and directed to lay down on a table, where researchers placed a polymer mask on her face to keep her from moving during the scan. The mask, still warm and malleable ("like a sci-fi facial," she says), hardened as it cooled. After reviewing the scans, researchers held a magnetic coil shaped like a figure eight over Kelley's scalp. When turned on, the stimulator emits a clicking sound over the noise of a vacuum cleaner. As it pulses on and off, it delivers little rubber-band snaps of electricity to the scalp for 30 minutes to an hour. These treatments are normally done multiple times over a period of weeks. Various recent studies have shown TMS to benefit about 30 percent of depressed patients, according to Lisanby.

At the time that Kelley was receiving TMS treatments in Bethesda, the brain-stimulation lab in New York began testing the procedure as well. Today, the lab is a leading center for TMS studies. In addition to being tested to treat depression, the brain-stimulation lab has studied its memory-enhancing effects on sleep-deprived soldiers and Alzheimer patients. The lab has also been a major player in the quest to get the FDA to approve the treatment.

Neuronetics, the Pennsylvania-based firm that manufactured the TMS device, presented the results of a study conducted in part at the brain-stimulation lab to an FDA advisory panel in January. Dr. Lisanby told regulators that she believed in the device: "As a psychiatrist that specializes in treating patients with medication-resistant depression who are frequently hopeless, I know that the only thing worse than no hope at all is false hope, and it's my personal evaluation of the data that TMS is not false hope."

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Twenty years of Colleen Kelley's memory was erased by electroconvulsive therapy, but she is still trying new forms of electro-magnetic treatment to ease her severe depression.
Colleen Kelley
Several TMS patients testified as well, reporting that repeated TMS sessions had eased their depression so substantially that they were able to return to work and begin to experience pleasure again. Martha Frankel, who received TMS treatments at the brain-stimulation lab, told the FDA advisory panel that the treatment was the solution she had sought for years.

"After being hospitalized, trying more than 30 different kinds of antidepressants that caused me to suffer major side effects, experimenting with other kinds of medications, attending about two years of psychotherapy and definitely not even considering ECT for the bad reputation associated with it," Frankel said, she decided to participate in a TMS trial led by Lisanby. "At first, TMS was painful," Frankel reported. "It felt like an intense snapping of a rubber band on my head. However, in a short time I became accustomed to the sensation—it was quite relaxing and usually put me to sleep." After a series of sessions, Frankel felt the depression lifting, and she urged the FDA to approve the device so others could be similarly helped.

Another patient, who said he'd lost more than 17 jobs because of debilitating depression, told the panel: "When TMS showed up on my horizon, I decided I would try that and then ECT, and if neither worked, I would strongly consider suicide." TMS chased the suicidal thoughts out, he said.

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