Duke researcher Sarah Lisbany talks to the Wake County chapter of NAMI about neuromodulation for depression.
By Stephanie Soucheray
The Snake Pit, One Flew Over the Cuckoo’s Nest and, more recently, Homeland.
Hollywood has used the images of electroconvulsive therapy, also known as ECT, to titillate and entertain for years. But a researcher from Duke University is hoping to change the frightening images that play in people’s head when they hear about “shock therapy.”
“The brain is an organ that responds to electricity,” said Sarah Lisbany, chair of the Duke department of psychiatry. Lisbany spoke to 50 people from the National Alliance on Mental Illness (NAMI) of Wake County on Monday about ongoing studies and clinical opportunities at the Duke Institute for Brain Sciences.
“Just like the heart, the brain can be targeted using electrical therapies that are often safe, and very effective,” she told the crowd.
Each year, depression and other mood disorders like anxiety and bipolar disorder, as well as psychotic diseases like schizophrenia, affect one-quarter of Americans.
Unfortunately, the first-line treatment for moderate depression, antidepressant medications such as Prozac, are only about 50 percent effective for most patients. Often, a patient will try a course of medication then be moved on to another while waiting the requisite one to two months to see if the drugs alleviate their depression.
“These drugs are often the best treatment we can begin with for some patients,” said Lisanby, “but if someone has failed a course of four different antidepressants, they need to look at other options.”
Lisanby spoke about neuromodulation — the term used for therapies that use electricity and magnets to change brain circuits associated with mood disorders and mental illness. Unlike medication, which targets neurotransmitters like serotonin and dopamine, neuromodulation targets nerve cells in the brain. The process is based on what psychiatry has gleaned from the last two decades of neuroscience: Depression isn’t just about a lack of neurotransmitters; it’s about faulty wiring in the brain and the shrinkage of brain structures.
“The really interesting thing about neuromodulation is that we can not only treat, which medications do, but also potentially cure mental illness,” she said.
Lisanby pioneered the magnetic seizure therapy (MST) method when she was at Columbia University. Like ECT, MST uses magnets to induce seizures in targeted parts of the brain, but is considered safer. The Duke alum (she attended undergrad, med school and residency at Duke) brought the technology with her when she returned to Durham in 2010.
Lisanby also spoke about transcranial magnetic stimulation (TMS), which uses images of the brain to guide clinicians in applying magnetic stimulation over areas associated with mood disorders. The process is non-invasive, and safe, with none of the need for anesthesia or risk of memory loss that comes with ECT.
She said that although her research is exciting, she still sees patients because they keep her clinically grounded.
“Depression kills,” said Lisanby. “I have people come to me because they are at the end of their rope and someone recommended ECT. They say, ‘Please let there be something else,’ but I tell them ECT may be exactly what they need.”
Though ECT does run the risk of some memory loss, it’s an incredibly effective treatment, with 80 percent to 90 percent of patients reporting an alleviation in depression symptoms.
On Monday night, many people picked up brochures about Lisanby’s work at Duke and asked about participating in clinical trials. Gerry and Ann Akland, the presidents of NAMI Wake County, said they were eager to host Lisanby, as her work gives people with treatment-resistant mental illness hope.
“We’re always glad to have someone talking about new therapies, or what’s on the horizon,” said Ann Akland.
Cover image: A woman gets her brain imaged before undergoing neuromodulation therapies. Image courtesy Sarah Lisanby