Featured in the “Thinking Bigger” section of the MHF 2017-2018 Annual Report.
While brain stimulation is no longer an emerging technology–it was first introduced as a neurophysiological technique in 1985–when Dr. Doug Urness first began offering it in Alberta in 2003, it had only just been recognized as a medical device by Health Canada
“We were looking for an opportunity to innovate after renovating the hospital,” says Dr. Urness, referring to the Centennial Centre for Mental Health and Brain Injury.
“The project came on the heels of a 1996 initiative to first establish telepsychiatry.” Video conferencing answered the need to reach out into the community, rather than exist simply as bricks and mortar. Repetitive Transcranial Magnetic Stimulation (rTMS) answered another pressing need.
“We knew that depression is particularly difficult to treat and that existing treatments had many imperfections. We were looking for alternatives.”
There was still a lack of clarity around the effectiveness of the technology, mainly because not enough research had yet been published on the subject. Even so, it was a new treatment for his patients with treatment-resistant depression who felt like they had run out of options. Out of compassion for his suffering patients, Dr. Urness purchased the equipment and began offering brain stimulation.
The clinic now sees 6 to 10 individuals a day for brain stimulation.
Before brain stimulation, electroconvulsive therapy was the only alternative for someone who had run out of treatment options. It is still practiced today, and is a valuable tool for treating severe depression, but it is considerably more invasive with more side effects.
Besides a relief of symptoms, rTMS enables individuals to live their regular lives during treatment. There’s no anesthesia required and a day isn’t needed to recover.
In Alberta, treatment-resistant depression is a big issue. Over 120,000 people suffer from Major Depressive Disorder, and of these, 30-60% have treatment resistant depression. Timely access to appropriate treatments helps people get on their lives.
And, says Dr. Urness, it should be more suited to their personal needs, more convenient for their lives. This is where brain stimulation comes in.
What does access to rTMS do for a person’s outlook? “People are pretty hopeful, pretty optimistic,” he says. Many people come in and are so desperate for relief, even seeing brain stimulation as their last chance for recovery. Dr. Urness doesn’t encourage that, but does say that any additional treatment option in a person’s toolkit is positive. “It’s an exciting, innovative technology. It means we’re not just stuck with the same old treatment.”
About two-thirds of people respond to the treatment, most moderately, some drastically. He’s had patients whose entire lives turn around. But Dr. Urness insists that’s not the only mark of success.
The biggest benefit I see from rTMS is that people are able to get on with their lives; they can return to work, perhaps get off some of their medication, and function better in their relationships. They don’t have to spend all their time being a patient.
The benefits go beyond clinical effectiveness. “Coming in for rTMS is a bit of a social event. It’s a chance to build strong relationships one on one.” Nurses are present for the duration of the treatment. They add to the positive atmosphere, catching up with individuals and potentially advising on lifestyle choices to accompany treatment.
One of the clinic’s nurses, Greg, shares a story, first explaining the relationship many of his patients have to their recovery. “There’s a spectrum of the success we see in response to rTMS. Some people get to a point, after coming out of such a long period of depression, that they’re functioning so well that they can literally feel when they’re in need of their next treatment.”
They call that the dip.
One of Greg’s patients, feeling the dip during a vacation in Hawaii and concerned that their mood would drop down, paid out of pocket to receive treatment while abroad. “That $350 dollars they paid is proof of how important this treatment is to them,” says Greg.
There’s definitely been a shift in how brain stimulation is perceived, says Dr. Urness. “The medical community is more aware; doctors have heard of it and know it’s not just hocus pocus.”
Nowadays, the clinic fields numerous calls from all over, even out-of-province. But having only one machine means that Dr. Urness’s patient load has to stay quite low: “the demand far outstrips our ability to respond.” Plus, brain stimulation is a long-term commitment. Many of his patients continue to come for maintenance treatments, so he must accept fewer new referrals. He has stopped taking referrals from out of town completely. “What’s the use if they just end up on a waiting list indefinitely?” Dr. Urness asks.
Unfortunately, the clinic’s capacity and its location is limiting. “People come quite a ways. Travel is difficult.”
Having a publicly available rTMS program in Edmonton ensures not only that more individuals in need will have access, but also that treatment is standardized across the province as the program rolls out. “Alberta Health Services can make sure there are no accidents, or that the treatment doesn’t get watered down.”
That’s why we look forward with excitement to the fall, when the first two of six rTMS machines will become operational in Edmonton, purchased thanks to our generous donors. You’re helping us change people’s lives.
“So many times people say they feel better, but nothing changes,” says Dr. Urness. “You really want to see a change in function. When I see someone get back to work, or able to do simple things like babysit their grandchild, that’s the most rewarding part. Brain stimulation is getting life back on track for people.”