The Egg & I
How an experimental treatment for major depression introduced me to the medical magnet and the return of 'energetic' medicine
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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.