Severe depression will strike one in five Australians at some stage during their lives. The illness can have devastating effects - it is the leading cause of suicide. Many people don’t respond to either drug therapy or psychological counselling. For over 60 years the only alternative has been ECT – more commonly known as shock therapy.

ECT has some serious disadvantages, not the least of which is that it frightens away many people who could benefit from treatment. But now there is hope thanks to pioneering new research in Australia that is developing an alternative treatment. The new therapy, Transcranial Magnetic Stimulation, or TMS, uses pulsing magnetic fields to change the way people feel.

TRANSCRIPT

Narration: Richard Stroud is bipolar. It’s a disorder which brings with it serious depression that is ruining his life. He’d all but given up hope of improvement before discovering this amazing experimental treatment. Pulsing magnetic fields are being used to try and change the way he feels.

Richard Stroud (patient): This is most important to me. I mean I‘ve dropped everything in my life… so I’m looking at this as close to a last chance effort of getting well.

Narration: News of this treatment has attracted patients from around Australia and from overseas. Richard Stroud has come to Melbourne all the way from his home in LA. An imaginative entrepreneur, he’d built a business turning over 10 million dollars a year. But the business crashed as the demons of depression took hold in his mind.

Richard Stroud: Your most important asset, your mind, instead of being your friend and your consort, suddenly becomes your enemy, and since it’s with you 24 hours a day, you have an enemy with you that knows everything about you working against you 24 hours a day. It’s a very intolerable position if you will.

Narration: Richard tried almost every imaginable treatment– endless combinations of drugs, and psychological counselling. But his depression became so severe it nearly claimed his life.

Richard Stroud: It comes to your mind that the only way that you would possibly stop it would be to be no longer. All you have to do to die is to stop trying and pretty soon you’ll die.

Narration: This is one therapy Richard has intentionally avoided. - Electroconvulsive Therapy, or ECT. For 60 years it’s been the last resort for people suffering severe depression. While ECT helps many patients, it does have serious disadvantages. It requires a general anaesthetic, which always carries a risk. And many potential patients are frightened away by the common side effect of memory loss.

Dr Paul Fitzgerald, Psychiatrist: ECT - it does have a tendency to produce problems with people with memory. In general most of those problems go away over time and are short-lasting, but there can be some lasting effects and people get very distressed by change in their memory.

Narration: Psychiatrist Paul Fitzgerald thinks he has an alternative to ECT. It’s called Transcranial Magnetic Stimulation or TMS. It has been tried before without much success, and most doctors still doubt it works. But now Paul and his team here at the Alfred Hospital in Melbourne think they’ve cracked the TMS puzzle.

Dr Paul Fitzgerald: I started out, particularly in this area, quite sceptical about how effective the TMS would be in depression. I have become convinced now that it works - now its really about developing into a tool that is highly clinically useful.

Narration: Richard is about to have his first treatment. The figure eight shaped magnet produces a short, intense magnetic pulse. Like the much older ECT, no-one knows exactly how TMS can change a persons feelings, but Paul has a theory.

Dr Paul Fitzgerald: Ee think in general that what happens is the magnetic pulses actually induce the nerves in the brain to fire. Like they would normally when the brain is active, but to make a large plastical groups of nerves fire at the same time. And by making the nerve cells fire repeatedly we gradually change their properties. By that I mean we can gradually make those nerve cells more likely to fire or less likely to fire in the future.

Narration: That’s important because depressed people have an imbalance in the activity on the two sides of their brain. But by getting the intensity and frequency of the magnetic pulses right, Fitzgerald believes you can ‘re-balance’ nerve cell activity.

Dr Paul Fitzgerald: We’ve got a type of TMS that increases brain activity, and we target that on the left side of the brain to try and make the left side more active. And we also have an approach that reduced brain activity, so we target that on the right side of the brain.

Narration: Throughout the 10 minute process Richard remains conscious and in relative comfort.

Richard Stroud: It felt like someone was tapping on the top of my head with a pencil maybe. I was more interested in whether this thing was going to hurt or not and it doesn’t.

Narration: It’s now four weeks since Richard began his daily TMS treatments. It’s time to take a look inside his head and see if things have changed. While his brain is being scanned, Richard solves a series of puzzles that activate his frontal cortex - the imbalanced area of the brain linked with depression.

Dr Paul Fitzgerald: So these are the scans, which he's had before and after his treatment. So on this scan what you see is the area of activation in the brain that's produced when he's doing those puzzles in the scanner. So he's thinking its activating areas in both his right and his left pre frontal cortex.

Narration: Before treatment Richard was using a large area at the front of his brain. But after TMS the scan reveals a dramatic decrease in the area of brain needed to solve puzzles.

Dr Paul Fitzgerald: After treatment it's significantly reduced. What this suggests is that when he reports feeling better there is concrete evidence from his brain that the TMS results in a reduction in activity in that area of the brain. How that relates directly to him feeling better is something we need to nut out, and we want to see that across multiple patients. But it's certainly very supportive of what we think's going on.

Narration: And even better news is the patients themselves feel. All the participants had failed to respond to both drug and psychological therapy, but TMS has enabled almost half of them to recover from depression.

Dr Paul Fitzgerald: It’s really been the response of our patients that convinces us that it is an endeavour worth pursuing. We’ve certainly got no doubt now that TMS works. It’s really a matter now of refining treatment and ensuring we’re able to deliver it in an effective way for the greatest number of patients.

Narration: There’s still a way to go before TMS becomes commonplace. Big companies have been unwilling to invest in treatment that can’t be patented. But if Richard’s experience is any guide, the long term future of TMS is assured. He’s emerged from his depression, revitalised and re-invigorated.

Richard Stroud: I’m alive again, its marvellous. And its going to get better I can feel its going to get better. This stuff is working. Thank God it’s working!

Story Contacts

Dr Paul Fitzgerald
Deputy Director
Alfred Psychiatry Research Centre
The Alfred Hospital
Commercial Road
Prahan Vic
Australia
Ph: +61 3 9276 6552

This is the number for Patients wanting information
Tim Brown
Alfred Psychiatry Research Centre
Alfred Hospital
Melbourne.
Phone 03 9276 6596
Phone 03 9276 6592

Related Info

Dr Paul Fitzgerald’s study

Info on Prince of Wales study

Beyond Blue- general resource on depression

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