Minds and Magnets

Anne had been expecting twins in a pregnancy that became complicated. One child, a son, died. Her daughter remained in a precarious state in the hospital for four months. Grief and worry led to postpartum depression and hallucinatory psychosis. Anne could barely function. She tried antidepressants, but felt no better until receiving repetitive TMS. In the last few years, she has had short courses of repetitive TMS about four times a year. She now works in a business with her husband, takes care of her children and describes herself as becoming what she was before she became depressed: a happy person.

The stories of Anne and Mark are stirring, but experts are still quite cautious. A relatively small number of patients have been treated so far, and the number of patients evaluated in controlled trials is also very limited. The maximum period of benefit averages around four months, at which point maintenance treatment can be offered and seems to work well. Though less intrusive than ECT, the treatment does require a complicated machine that has to be operated by a skilled technician in a controlled environment. It may have fewer side effects than medications, but it is more expensive and less convenient. There is also much to learn about how repetitive TMS interacts with standard drug treatments.

Repetitive TMS is already available for depression treatment in Canada, Australia, New Zealand, Israel and the European Union. The FDA may rule on repetitive TMS as a depression treatment in early 2007. Approval here would be good for Anne and Mark, because they now pay out of pocket for a treatment that costs about $300 per session. They don't feel they've been mesmerized. "If there was going to be a placebo effect," asked Anne, "couldn't it have happened sooner with one of the medications I tried?" Their interest in talking about their experience is propelled by vivid memories of the pain of depression and the subsequent relief. They know the hard work of living with the illness and the frustration of trial-and-error treatment. They encourage people to stay with it. Like many health-care professionals and patients, they hope depressed patients will have more options available. Because right now, there are still too few.

Miller is editor in chief of the Harvard Mental Health Letter and a member of the faculty of Harvard Medical School. For more information go to health.harvard.edu/NEWSWEEK.

© 2006