A personalised alternative to antidepressants is on the way

A personalised alternative to antidepressants is on the way

Paul Fitzgerald

Beyond recognising and addressing the importance of social interventions to ameliorate the external conditions that can contribute to mental health problems, the treatment of depression is currently evolving in unexpected ways. This is based on a shift away from thinking about depression as a disorder of ‘chemicals in the brain’ to an understanding that depression is underpinned by changes in electrical activity and communication between brain regions.

Unbeknown to most of the public, there’s a new therapy, now established in clinical practice, called transcranial magnetic stimulation (TMS) that can address some of these brain-based changes seen in depression. In TMS, a figure-8-shaped coil held over the head generates a magnetic field that stimulates localised brain activity and the strength of connections between multiple brain regions. To treat depression, the TMS pulses are usually targeted to the front of the left side of the brain, a region that is consistently underactive in patients with depression. Although several decades of clinical trials have established the effectiveness and safety of TMS, especially for patients who have not responded to standard antidepressant medication, an ongoing challenge is that it is time-consuming and inconvenient. Patients must attend a clinical setting on a daily basis, five days per week, for up to 6 weeks.

For this reason, efforts are underway to develop alternative forms of brain-stimulation treatment that could be administered in a patient’s home. Of these, the research is most advanced for transcranial direct-current stimulation (tDCS), a surprisingly simple process, the ideas behind which are not new. People have experimented with the use of electrical currents to change brain activity since Scribonius Largus, physician to the emperor Claudius, applied a type of electric ray to the brain during the time of the Roman Empire.

Hmm,

This is based on a shift away from thinking about depression as a disorder of ‘chemicals in the brain’ to an understanding that depression is underpinned by changes in electrical activity and communication between brain regions.

Is this a step sideways from a materialistic explanation to a materialist explanation?

Having experienced depression more than once, the initial onset seemed to coincide with both external stresses and changes in ideas and thinking about the world. That might relate somewhat to the idea of "communication between brain regions" but maybe there's an unwillingness to call this by the everyday term, namely thoughts.

I know from my own experience that it can be extremely hard to extricate oneself from what might seem a self-sustaining loop. Perhaps the aim is to find some way to disrupt the chain through any of several different means.

However, after the early (many years ago) prolonged initial occurrence, I've had occasional briefer and less intense experiences. I've more recently considered there is a spiritual or should I say perhaps external force or entity involved. I know language like this might suggest something quite extreme, but I've had times when depression has stopped and started instantly, feeling like an oppressive force entering and then being ejected. Or in a different language, it felt like entering and leaving different rooms of light and dark by passing through a doorway. I'm just trying to describe my experience rather than necessarily describing a mechanism.

Maybe where I'm going with this is an idea that we are swimming in an ocean of spiritual forces of which we are often unaware, and that we can perhaps learn to recognise and control which of these we make welcome and which we shut out. Here I should add I mean no disrespect or lack of compassion towards anyone suffering with depression.

Maybe where I'm going with this is an idea that we are swimming in an ocean of spiritual forces of which we are often unaware, and that we can perhaps learn to recognise and control which of these we make welcome and which we shut out. Here I should add I mean no disrespect or lack of compassion towards anyone suffering with depression.

I agree. I actually think there needs to be a way to talk about depression as not a sign of failure on the person having those feelings but also not negating the person's ability to take some action toward their own mental health.

The question of neurological issues, which seem to be one the rise, is part of why I am wary of thinking of the brain as *just* a transmitter/filter. It makes it too easy to insist that people are just not trying hard enough to overcome their depression/anxiety/etc. OTOH insisting that all these issues are out of our control b/c free will is an illusion also seems to create a culture of wallowing rather than a desire to engage in the at times seemingly Sisyphean task of combating these illnesses.