I can still remember the moment when I first felt depressed. It was October 2001. I had just turned 24, and was listening to a Spiritualized album when suddenly, the lyrics resonated. Life was a pointless charade; I would never achieve my potential; effort was rewarded with suffering.
That was the headspace I’d live in for the next 14 years. The depression never really went away. Some days were lenient on my psyche, while others were so treacherous that thoughts of death, drinking, or smoking industrial quantities of weed seemed the only escape.
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But for the first time in a long time, I am not depressed. I’m still on meds but the feared apparition, the depressive state, has not come to visit for weeks. I am convinced there is only one reason why and it’s almost a miracle—a relatively new procedure called repetitive transcranial magnetic stimulation, or rTMS.
My neural pathways were hopelessly clogged, but how to rearrange my cortex?
“A better way to think about depression is more like a traffic jam,” said Dr. Jonathan Downar, an assistant professor of psychiatry at the University of Toronto, who led my treatment at Toronto Western Hospital. “The brain is a network just like the city streets of Toronto. A healthy city alternates between different patterns of traffic as it goes through all its functions. So if you look at a healthy city you’ll see it oscillating. In depression, two or three of these networks take over and they dominate the brain activity. It’s a little bit like if morning rush hour started and went on for 18 hours a day.”
If Dr. Downar’s analogy applied, my neural pathways were hopelessly clogged. But how to rearrange my cortex? Enter rTMS. The procedure works by inundating a specific region of the brain with targeted, oscillating magnetic fields which cause the nerve cells, or neurons, to fire. By artificially activating neurons in a specific network over and over, the treatment attempts to reset the repetitive “traffic jam” patterns seen in a depressed brain by gradually strengthening the less dominant networks over time. I wanted to see if it would work for me.
Dr. Jonathan Downar, an assistant professor of psychiatry at the University of Toronto, who led the author’s treatment at Toronto Western Hospital. Image: Paul Tadich
I was hopeful. In one of the first studies to look at the efficacy of rTMS in 190 patients with major depression in the US, 30 percent of those who did not respond to medication saw a remission of their symptoms. Another study from last month looked at the effect of rTMS on major depression, six months after the treatment ended. The conclusion was a “significant” antidepressant effect amongst patients who either did not respond to or tolerate medication.
That gels well with the type of result Dr. Downar told me to expect: a third of patients see no effect; another third show improvement and the final third see their symptoms vanish completely.
There are potential side effects—including headache and muscle twitching—but in the vast majority of cases these are easily tolerated. And although in rare cases seizure can occur, the side effect profile of rTMS is still much safer than what you would encounter with a pharmaceutical.
I first encountered Dr. Downar’s work when I was doing research for a story about different types of brain stimulation. The more I learned about the rTMS technique, the more I wanted to try it for myself. All it took was a referral from my psychiatrist, and a couple of weeks later I was at Toronto Western preparing for the treatment. I would do one ten-minute session each day for a month.
The first step was to get a high-resolution MRI scan of my brain. Then, a camera connected to a computer tracked the location of my head, and overlaid the image with the MRI scan. This was so Dr. Downar and his team could locate a structure called the left dorsolateral prefrontal cortex. It’s a small region that has a big responsibility: it’s involved in working memory and the ability to multitask. Then the fun began.
The device that controls the magnetic pulses is a box the size of a desktop computer connected to a butterfly-shaped coil that is placed atop the scalp. Magnetic fields pulsed through the coil into the depths of my brain. Because muscle tissue is also stimulated by magnetic fields, each pulse from the machine caused my facial muscles to sharply contract. It hurt. But my body adjusted, and the discomfort diminished.
This is the box that delivers the magnetic pulses to a handheld device. Image: Paul Tadich
About two-thirds of the way through the 30-day treatment, I noticed my mind was changing. I was still depressed, but my I felt like my focus was clearer and I had a greater desire to tackle tasks at work. But as week five arrived, I fell off a cliff. I was in the dark, velvety folds of a full-on depressive episode. I felt hopeless. Still, my brain felt different.
Then, at the six-week mark, my depression simply melted away. For the first little while, I was in disbelief. Could this really be happening? I could often feel myself experiencing a tick of sadness, but, whereas before the treatment it would have blossomed darkly into a recursive loop of depressive thoughts, it now failed to gain a foothold.
There is no question about it. rTMS changed my life. In early October, about six weeks after I finished treatment, I had my final follow-up appointment and Dr. Downar explained my spectacular results were in the top quintile of patients. However, he cautioned against me thinking I was permanently cured. It’s quite usual for the effects of the rTMS to fade after about six months.
If that happens, I will be readmitted to treatment for a series of “booster” sessions which should get me back up to speed again. It seems that my depression is still a chronic illness which requires long-term and consistent care.
rTMS doesn’t work 100 per cent of the time, but it helped me in a spectacular way. I’m not planning on ditching any of my medications, but people who suffer from a milder form of depression may find rTMS is what they need to keep their symptoms at bay.
