Affecting
hundreds of millions of people worldwide, depression remains the most
widespread mental illness across the globe. Chances are, you know at least one
person affected by depression’s debilitating effects – as 1 in 10 Americans are
affected by its symptoms, and that number is even growing. Personally,
depression really fascinates me because it affects such a widespread number of
people, yet so little is known about how to effectively treat it. Maybe because
it is caused by such a complex combination of social, biological, and
psychological factors, treatments aren't always
effective in helping eliminate symptoms. But recently, new
experiments are providing insight into a specific type of treatment that,
surprisingly, has shown such positive effects – electric shock therapy. As
harsh and intimidating as this sounds, it’s actually showing to be effective in
even the most severe of patients. Now we want to know, most importantly – why.
The man
behind electric shock treatment is Dr. Ian Reid, a psychiatrist at the
Royal Cornhill Hospital located in Aberdeen, Scotland. He’s been treating
severely depressed patients for 25 years, and witnesses that the disease is an
extremely horrible illness. Typically patients who come to Reid’s hospital
having major depression first receive a combined treatment of psychotherapy and
antidepressants. Usually, less than half respond to their first medication, and
10-20% respond to no medication at all. In these cases, Reid turns to his third
and final option, in which he is an expert – officially called
electroconvulsive therapy, or ECT, commonly known as shock therapy.
Dr. Reid is
an expert on ECT, and has received an incredible amount of criticism and
hateful comments for his use of it on patients. People are shocked (no pun intended) by its use as a
medical practice to treat depression, mostly because of the stigma of cruelty
and torture associated with the practice. Although the movies typically depict
shock therapy as a gruesome process, the actual therapy is not this way –
patients are given anesthesia and muscle relaxants, and most importantly, they see results. It seems a little bizarre and twisted, but the
numbers line up: in Scotland out of a population of about 5 million, 400 people
receive ECT treatment each year for depression and around 75% of them are
relieved of symptoms. For some reason, shock therapy outperforms the
traditional psychotherapy and antidepressant treatment, but just why is a
mystery. It sounds a bit convoluted that making someone have a seizure and
giving them an electric shock will somehow make something as intensely complex
as depression better.
Electroconvulsive
therapy was first used in 1938 to treat schizophrenic patients in Italy, where
it then spread to uses for other diseases in other countries. Although it was
clearly effective, it could be a frightening process as patients blacked out
after seizures, sometimes breaking bones too. In the 1960’s, doctors added
anesthesia and muscle relaxants to the treatment in order to prevent this from
happening, but memory loss was still a prevalent problem. In the 1980’s, the
treatment was further developed to now become a series of short compulsive
shocks instead.
Reid has
now made it his mission to find out how ECT works on patients. According to
previous studies, it was known that depression reduces the size of certain
brain regions, including the hippocampus and gray matter (both involved in
expression of emotion). So in 2009, he set out with colleagues to use fMRI
(functional magnetic resonance imaging) to scan the brains of patients pre-ECT
treatment, followed them through the therapy process, then followed up with
post-treatment scans. The scans showed that after ECT, the hippocampus was
often increased in size, but the gray matter was not.
Reid and
his colleagues also investigated another more significant change: how ECT transforms
the brain’s communication with
itself. Every region of the brain specializes in specific mental tasks, and
each of these regions communicates with the regions around it – like a network of parts working closely in tandem. In some brain disorders
like Alzheimer’s and schizophrenia, it has been found that these diseases alter
the connectivity of certain networks and inhibit regions from communicating
with one another. So, in an attempt to discover if this was the case in
depression, Reid teamed up with Dr. Christian Schwarzbauer to test this on ECT
treatment.
Reid and Schwarzbauer set out to analyze brain scans in depressive ECT patients
for changes in connectivity. Typically when neuroscientists want to measure
connectivity in the brain, they select a few large regions to measure blood
flow between – Schwarzbauer however divided the brain into 25,000 separate chunks and measured connectivity between all of
them, looking for important changes before and after ECT. Talk about
dedication. This fine-tuned approach revealed a significant discovery: ECT
weakened the same connective network in all 9 patients.
This region, surrounding a single
hub located above the left eye, is in a brain region called the left
dorsolateral prefrontal cortex. As Reid and Schwarzbauer investigated this area
in search of a cause, they found previous research indicating that in case studies of depressed people, this network of the brain
was “hyperconnected.” So, they speculate that perhaps in depressed individuals,
the hyperconnected network excessively bounces thoughts back and forth around
the brain, causing an internal information overload. So as shock therapy
weakens the connections in this region, it’s possible that ECT allows depressed
people to “get out of their own heads” so to speak.
The hypothesis is now currently
being tested on patients, and if Reid and Schwarzbauer are correct, hopefully a
big breakthrough will lead to a better understanding of depression as a mental
illness. Although the study doesn’t clarify the question of how a jolt of
electricity to the brain gets rid of hyperconnections, researchers are hopeful
that future research will soon make it clear. Hopefully, in time, this could
lead to a better long-term treatment that would give the same effect.
For the 1 in 10 Americans, the
hundreds of millions around the world, and for family members and loved ones
affected by this debilitating illness – this is incredibly good news. As shocking as it may be, a jolt of
electricity to the mind may actually be the key to happiness? Scientists aren’t
out of their minds – but it will definitely get you out of yours.
-Madeline Kleypas
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