The Egg & I
How an experimental treatment for major depression introduced me to the medical magnet and the return of 'energetic' medicine
I'm on my back in a dimly lit room on the seventh floor of a Dallas research hospital. A device roughly two feet tall resembling an oversized egg is wheeled up behind me, its single blue clawlike appendage nestled possessively over the top of my head. "How's that?" the doctor asks.
A thumb drive containing my information is inserted, and a man's tinny voice buzzes from within the plastic shell announcing that a session is available. "Lie still with your eyes closed. Treatment begins in five, four, three, two, one. Treatment begins now."
Rattalattarattalattasqueeeeak! Rattalattarattalattasqueeeeak! Rattalattarattalattasqueeeeak!
Welcome to the future of psychiatric care: low lights, an old massage table, and three spinning magnets. In a world seemingly awash in chemical solutions and all the hardship that has come to entail, prepare yourself for the rise of bioenergetic medicine. In the six-week, double-blind study sponsored by device manufacturer NeoSync, neither I nor the doctor administering treatment know if the ergonomic appliance vibrating on my head is generating a potentially therapeutic magnetic field or merely rattling in place.
"OK. I'll be back to check on you," says the lab-coated doctor in calf-length boots and with long, springy curls, as she drifts past a sign warning of strong magnetic fields. I'm to keep my eyes closed but not fall asleep. If the device, an object of intense interest at 16 human clinical trials taking place around the country, is indeed functioning, there should be three magnets spinning inside, generating an energy field timed to oscillate across my brain's surface at the same frequency as my own unique alpha wavelength of 10 cycles per second.
The hope is that the energetic boost delivered by that magnetic field will stimulate patches of my brain that have grown quiet, if not dormant, stilled by decades of drug-resistant depression. I try to imagine what these awakened neurons – transmitters that in healthy brains communicate things like happiness and pleasure – would mean, before cursing myself quietly, as depressives will do, for thinking things could be different.
Crisis of Last Resort
So many doomsday predictions didn't come to pass in 2012. No supervolcanoes shook the earth or blacked out the sun. No sudden magnetic pole shifts wreaked havoc on GE, Telefon, Boeing. Sadly, no interstellar conquest came to subjugate our wayward species. A space rock fell, but it arrived two months late to a less-than-catastrophic result over Russian skies.
Yet when December 21, 2012, dawned on Texas – the widely publicized "last" day of the Mayan calendar – I was hemmed in on all sides, a defeated, humiliated wreck consigned to spending my days on the couch, moving unsteadily from room to room in an increasingly thick, pharmaceutical-induced haze. After decades of battling depression, an explosion of daily panic attacks leading to a deepening despondency brought me to the point of psychological collapse, hastened my departure as editor of the San Antonio Current, and forced me to grudgingly accept that I was disabled at 42.
While it took months to get an appointment with a psychiatrist, the array of drugs that followed – daily doses of Prozac, lithium, Wellbutrin, Klonopin, and sleeping pills – likely saved my life. However, my new chemistry felt like engaging the gears of a duller, more drawn-out death. I became a strange creature; cautious, methodical, and distant.
I holed up, terrified of having to explain my sorry state, watching seasons of old TV dramas. I volunteered once a week in a downtown church basement that doubled as a homeless services center, the only place I felt a sense of belonging or acceptance. And that's where things could have stalled for a very long time, as they do for many diagnosed with a mental illness, grudgingly coming to terms with newly restricted abilities punctuated by periodic breakdowns, medication tweaking, and dim hopes to one day be of use to someone again.
A suicide scare led me to the ER and, later, into an outpatient program at a mental-health facility where doctors recommended electroconvulsive therapy, historically the treatment of last resort for depressives. But I already had my eye on something else, a magnetic treatment I had written about two years earlier: a safer, noninvasive therapy called transcranial magnetic stimulation.
Of course, my case was far from unique. These days, depression touches everything. It is the leading cause of disability worldwide in terms of lost work, draining the U.S. economy of an estimated $36.6 billion per year. By 2030, the World Health Organization expects depression to be the most damaging illness – socially and economically – in upper-income countries, outdone only by HIV/AIDS and early childhood mortality elsewhere.
Despite these epidemic numbers, cultural stigmas surrounding mental illness and the lack of resources allocated to assist the suffering mean as many as half of the afflicted never receive treatment for their conditions in this country, according to the WHO. In a report released on World Mental Health Day, October 10, 2012, UN Secretary-General Ban Ki-moon took the opportunity to call for a more honest and open dialogue about depression, what he called an "under-appreciated global health crisis."
It's strange to think that an epidemic estimated to impact 350 million people around the globe still needs defining. There should be no mysteries, no surprises surrounding any "global health crisis." Biologist, author, and former depression-sufferer Lewis Wolpert struggled to give the illness its due by naming his 1999 work Malignant Sadness to "emphasize the very serious nature of a depressive illness and also to reflect my conviction that normal sadness is to depression what normal growth is to cancer.
"Severe depression borders on being beyond description," he continues. "It is a quite different state, a state that bears only a tangential resemblance to normal emotion." Symptoms include a scattershot of maladies such as sadness, numbness, dullness, apathy, suicidal thoughts, crying spells, irritability, anger, insomnia, lethargy, fatigue, hallucinations, delusions, difficulty concentrating or making decisions, hopelessness, loss of self-esteem, anxiety, hypochondria, loss of interest, inability to feel pleasure, and on, and on.
But perhaps the strangest thing about depression is that despite hundreds of millions of dollars sunk into research and treatment over the years, and the seeming discovery of one miraculous drug after another, mental illness in America is still booming. While the number of adults in the United States on disability due to mental illness has climbed from roughly 500,000 in 1950 to 1.25 million in 1987 to 3.97 million in 2007, the real tumult is happening among those still transitioning into the workplace. A 2008 report of the U.S. General Accounting Office reported that one of every 16 young adults – or 2.4 million – between 18 and 26 had a "serious" mental illness in 2006. And even that figure is likely to be greater than reported, since the incarcerated, institutionalized, and homeless – populations known to harbor high numbers of mentally ill – were not counted in the study.
Either there is something in the metaphorical water or there is a serious problem with the way mental illness is diagnosed and treated. Or both.
Correcting Grand Mistakes
What lies behind that epidemic is the million-dollar question. Like the collapse of global honeybee populations, contributors to depression seem to be everywhere and definitive answers nowhere. Exposure to environmental toxins is known to contribute to mental illness. As do food allergies, inflammation, and the Standard American Diet. The role of bacteria, inherited genetics, trauma, and substance abuse are also understood to play a role, and research continues into possible contributions made by electromagnetic radiation emitted by power lines, cell phone towers, and Wi-Fi networks.
However, as psychiatry's bible, the Diagnostic and Statistical Manual of Mental Disorders, has continued to widen the definitions of who should be considered sick, the medical response has narrowed. Psychiatric drugs have become the first – and frequently the only – prescription offered by psychiatrists. In our quick-fix culture, people frequently don't even take the time to get them from a psychiatrist, going instead to the family doctor with specific Google-informed drug requests.
"I see lots of people who get put on anti-depressants and anti-anxiety medications a couple days after a death in the family, by their primary care docs," said Austin-based psychiatrist Dr. William M. Konyecsni. "Well, feeling sad after a death is normal. I've also had parents give their kids their medication and they don't think twice about it, and we're talking things like Klonopin and Xanax. I mean, we have to experience and feel things to learn and grow. Not all of it is bad." These powerful chemicals change the way people's brains work, even those without the diagnoses that are presumed to have preceded their use. Some have begun to challenge the long-term implications of that practice.
"In the last 30 years, we've greatly expanded the boundaries – or psychiatry has – of what is considered ill. More people are getting treated, too. From a societal point of view you want to ask: Is that a good thing?" said author Robert Whitaker. "Are they better off five years later, 10 years later? ... Are they in less psychological distress? Unfortunately, the evidence it just not there."
Whitaker, an investigative journalist turned burr under the saddle of Big Pharma, insists in his most recent book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, that the long-term outcome is actually worse for those placed on psychiatric drugs than for those who go without. Though his work has historically stressed the troubling history of anti-psychotics and schizophrenia, Anatomy unearths numerous case studies that show similar patterns at work in the popular treatment of anxiety, depression, and bipolar disorder. "There's pretty good evidence that the drugs increase the chronicity of the disorder in the aggregate. That does not mean nobody is doing well on the drugs. People are. It's just that it doesn't improve their recovery rates [in the long-term]; it actually worsens their recovery rates."
Whitaker's books have found fertile soil among those collecting the growing catalog of research into nonpharmacological approaches to mental-illness treatment: everything from movement and dance, to prayer and meditation, to acupuncture, yoga, powerful vitamins or "nutraceuticals," and pulsed magnetic fields. A handful of psychiatrists are also starting to take notice.
At the National Alliance on Mental Illness's annual conference earlier this year, Dr. W. Clay Jackson, assistant professor of psychiatry at the University of Tennessee, issued a stirring critique of rampant "biological reductionism" that has crowned the biochemical response to depression, to the detriment of numerous other valuable approaches. "I think we've made two grand mistakes in approaching mental health in this country," he said. "We have stigmatized persons who have mental illness, and we have separated it from biological illness.
"It's led to an explosion of pharmacotherapeutic options, but it's led to a relative paucity of nonpharmacologic options for patients to follow – or at least nontraditional, nonallopathic options," Jackson said.
Among the less-heralded approaches are some perhaps surprising results only now getting nods from Western medicine. In addition to the expanding literature confirming the folk wisdom about exercise, sunlight exposure, social and spiritual networks, and good diets (particularly those rich in omega-3 fatty acids), researchers have found that "yoga nidra" – a deep sleeplike state of meditation – increases dopamine creation by 65%. (While many anti-depressant drugs seek to raise serotonin levels in the brain, dopamine is an equally important neurotransmitter associated with feelings of pleasure.) Naturally occurring SAM-E (S-Adenosylmethionine), and the old herbal standby St. John's wort, have both proven to be effective anti-depressants. And as our understanding of the body's bioelectrical nature grows, we can now add to that pile of proven depression-busters pulsing magnetic fields.
A Magnetic Breakthrough
I first witnessed the magnetic approach to depression treatment in 2010, when I walked into a nondescript San Antonio clinic and found a golf-shirted man with a football player's physique flirting with a Skittles-chewing lab tech. Then, in his sixth week of treatment with transcranial magnetic stimulation, or TMS, "Jay" told me he had been struck by a bolt of anxiety so powerful and inexplicable a quarter-century earlier that he thought he was having a heart attack. At the ER, however, the college student was told that he was simply too stressed out. He went home, but the panic attacks didn't stop. "I ended up just going through and grinning and bearing it," he said. He started having difficulty concentrating. His memory weakened. He obsessed over his deteriorating condition to the point that the undiagnosed anxiety disorder mutated into deep-seated depression. The only thing that kept him going was the belief that science would one day figure things out, that someone would invent a way out of his torment.
For him, that day arrived on December 16, 2008, when the U.S. Food and Drug Administration "cleared" Neuronetics' NeuroStar TMS device for medical use. Equipped with coils originally designed to treat incontinence, according to the health care newsletter In Vivo, the device was pitched as a safer, if less effective, alternative to electroconvulsive therapy. While the FDA panel deadlocked on that argument, it ultimately cleared the device on the basis of its lack of serious side effects and (as one member put it) "marginal" demonstrated effectiveness.
Overshadowing the FDA's clearance and perhaps loosening the standards for expected effectiveness was the Star-D study, the largest study of treatment-resistant depression ever undertaken. Published in November of 2006 in the American Journal of Psychiatry, the NIMH-funded Sequenced Treatment Alternatives to Relieve Depression study showed that even after multiple medications and behavioral therapy, modern psychiatric practice could only bring two-thirds of sufferers to full remission. It proved to be a major embarrassment. It wasn't a time to turn away even marginally effective alternatives. However, the health wing of the D.C.-based advocacy group Public Citizen protested the decision, suggesting that data showing the device was slightly better than treatment with a placebo had been manipulated to give the device the appearance of effectiveness. "It is concerning that FDA has cleared this device," the team wrote, "particularly if patients are diverted from effective therapies such as antidepressant medications."
Even with so little to recommend it, there were believers like Jay, who told me that after only his second treatment, TMS broke through his emotional dead zone and gave him a momentary glimpse of "normal" emotion for the first time in years. After more than a month of daily magnetic treatments, the man who estimated he had taken 15 different medications battling his entrenched illness, called TMS a "miracle," a "cure." It wasn't a testimony I would soon forget.
Science or Fiction?
When my own health deteriorated in 2012 and electroshock was urged, I made up my mind to first try TMS. The trouble was the cost. My insurance provider, Aetna, refused to cover the treatment, calling it "experimental and investigational." The price of $500 per session I was quoted (multiply that by an estimated 30 sessions, as is typically recommended) had me swooning, even as the woman on the other end of the line said cheerfully, "We do offer financing."
I began to scour medical trials online for TMS-related studies. That's where I discovered NeoSync's "egg," and what may become the latest magnet-based depression therapy to enter the mental-health market. All told, the magnetic devices manufactured by groups like NeoSync, Neuronetics, and Brainsway represent a growing movement away from purely biochemical treatment options, and the rise of "energetic" medicine, a growing acknowledgment of fundamental principles informing many traditional healing systems, though packaged and sold in decidedly science-fiction skins.
First to the market, the NeuroStar TMS device releases 3,000 pulses of electromagnetic energy per treatment session that generate an extremely weak electric current about an inch inside the left side of the frontal portion of the brain – the dorsolateral prefrontal cortex. Those currents have been shown to increase blood flow, elevate metabolic processes, including the production of glucose, and re-engage neurons. And TMS's promise appears to be growing as methods of delivery are tweaked.
A 2012 study led by Dr. Linda Carpenter, chief of the Mood Disorders Program and the Neuromodulation Clinic at Butler Hospital, surveyed 307 clients of 42 clinical TMS therapy sites and reported an overall positive response rate of 58% among those who had been unable to benefit from previous anti-depressant treatment; 37% achieved full remission. In a follow-up study presented at the annual meeting of the American Psychiatric Association in San Francisco earlier this year, Carpenter reported that 68% of 257 patients observed 12 months after treatment with 4-6 weeks of daily TMS and continued anti-depressant treatment showed "significant improvement," and 45% were in full remission.
Marilyn Vaché at the Austin TMS Clinic for Depression said her results have been even better. "At least 65 percent have had that significant improvement. That means if they started out with severe they went down to mild. If they started out with moderate to mild they went down to remission. Fifty-one percent were in the remission category," Vaché said.
Konyecsni, who only started offering TMS at his psychiatric practice about a year ago, said all eight of his adult patients have achieved remission.
Signs of Trial
Martha Rhodes first received TMS treatment in 2010. Like me, the former NYC ad exec had suffered for decades, done poorly on a range of pharmaceuticals, and shied away from ECT. She was desperate for something outside psychiatry's traditional toolbox when her sister faxed her a full-page ad from Connecticut Magazine trumpeting the "newest technology to treat depression without discomfort or drugs."
For Rhodes, TMS took three weeks to start pulling her out of her death-wish depression, and that followed a dangerous mood dip in week two. "Your brain is being reconnoitered," the author of 3,000 Pulses: Surviving Depression with TMS and 3,000 Pulses Later: A Memoir of Surviving Depression Without Medication told me. "You could experience happiness, then sadness, then happiness again. It takes, I'm going to say, a good 20 visits."
In my dim room, I drifted through multiple levels of awareness as the egg did its thing in the fourth week of the trial. Out of the darkness and the day's troubled thoughts I felt a moth fluttering against my right ear and cheek. Would I break protocol if I swiped after it? Opened my eyes? I mentally tracked the fluttering for what felt like minutes. Velvet wings brushed against the invisible hairs above the earlobe, almost imperceptible insect steps moved along the ear's ridge before the fluttering sensation resumed again. It dawned on me that the likelihood a moth was haunting the research hospital testing room was probably low.
Were these nerves activating? I watched again and observed a slender pain move through the inside of my cheek. Felt another energetic tentacle spread behind my eye. If the electrical stimuli around my head and face suggested I was not getting the placebo treatment, a coexistent surge of sadness – brought on by my inability to get insurance due to my mental-health history – also meant that even a cutting-edge depression-buster wasn't an automatic happy pill.
In those first weeks, I'd gone through days of high agitation, suffered a multiday migraine, and started having trouble sleeping – all things the attending doctor warned I could experience. But I'd also discovered newfound physical energy and a noticeably sharpened mental acuity that allowed me to steam through book after book on psychology, psychiatry, electromagnetism, religion, and shamanism. "The stuff is happening," I wrote at the time. "I'm sure it's the device."
I have questions about the trial, but regrettably, NeoSync chose not to participate in this story. The Office of the Attorney General of Texas, meanwhile, supported arguments made by UT Southwestern to keep secret specifics of the study I requested under the state's open-records law.
Researchers had been examining transcranial magnetic stimulation, or TMS, for its ability to aid in the treatment of Parkinson's, tinnitus, schizophrenia, and the recovery from stroke symptoms for years. When I dug into the literature, I found that magnetic fields are foundational to both the geophysical and the biological. Life evolved in Earth's reliable field of 8 pulses per second and everything from antibiotic treatment, cellular healing, and mental regeneration have all been shown to be influenced by them. Electromagnetic fluctuations from our star have been shown to have real impacts on our health. Validating theories of that 18th century healer and proponent of "animal magnetism" Franz Mesmer, researchers have been able to link sunspot activity disrupting our natural geomagnetic field with increased rates of psychotic behavior and institutionalization.
Michael Persinger, a researcher at the Consciousness Research Lab at Laurentian University, even found a correlation between 37 years of haunting reports and recorded geomagnetic activity. He published his findings in Neuroscience Letters in 1998, as detailed in Mary Roach's book Spook: Science Tackles the Afterlife, and went on to demonstrate that drops in melatonin levels brought on by exposure to high electromagnetic frequencies can inspire encounters with "synthetic ghosts" in a laboratory setting.
Small Steps Forward
My energetic rush, a generative vitality I hadn't felt in many years, continued for about two months post-treatment. In my first two weeks back in San Antonio, I set up a home office, fixed a collapsed wall shelf and assembled a floor shelf for my daughter's room, got caught up on all my bills, patched my windshield and changed my oil, dragged two old bathtubs around the backyard for a lettuce patch and a pond, did my laundry, got my hair cut, swept and mopped the house twice. The list goes on. I was functioning on a level vastly higher than I had been before treatment – still without drugs.
I came out in far better shape than I went in. But there has been a retrenchment of late, a slow return of brooding and ambivalence. "The whole concept of TMS is still theoretical. However, data would clearly suggest that the technology works," said John Carnuccio, CEO of NeoSync. "Duration is an uncertain, an unknown."
Rhodes suffered a relapse, but pulled out with 10 TMS treatments and now receives TMS twice a month for maintenance, she said. She's not an anomaly. "Based on my experience, there's probably a third of people who will relapse and need additional treatments," Vaché told me. "If we catch them early, we can sometimes get them back with three to 15 treatments." Given that depression tends to be a "lifelong" condition, Carnuccio said he hopes his company's device will be one people will be able to check out from their doctor's offices for self-administered daily home treatments. "It's a pretty simple device," he said. "It can be done in most hands, but not everyone's hands. But that's our objective."
In an interesting twist, "lots" of trial participants developed the need for traditional therapy during the NeoSync trial in Dallas, many for the first time. "Because they have all these new emotions bubbling up," the doctor with curls told me, waggling her fingers in the air. "Drugs and this [gesturing to the egg] can't do everything."
From the couch, I pine for the coming health care reforms of the Affordable Care Act that will force the insurance companies to accept people like me, people whose health and health troubles "pre-exist." While Vaché said some of her clients have been able to get their insurance providers to cover their TMS treatments, they're in the minority, and the compensation rates remain far from adequate to cover the costs of the treatments, Konyecsni added.
The egg and the growing number of devices like it do quite a lot, I've found out. If Dr. Persinger's high-frequency fields truly do create "ghosts" in the mind, the lower-frequencies provided by TMS appear equally capable of dispelling them.
At least most of the time. For a time.
Greg Harman is an independent journalist and longtime environmental reporter based in San Antonio, Texas. His environmental work can be seen at harmanonearth.com and his writings on depression are available at depression-time.com.