Fixing the Neural Circuit to Combat Mental Illness
New research with TMS brings hope for better treatment for mental illness
Posted Jun 29, 2015
As I studied the brain scans of two people, one suffering from Post Traumatic Stress (PTS) and one not, Dr. Amit Etkin explained the difference. When presented with a conflict, the brain sans mental illness lights up, whereas the brain suffering with PTS does not. Etkin, Assistant Professor of Psychiatry and Behavioral Sciences at Stanford
University, has seen this repeated in thousands of scans for a wide range of mental illnesses. He believes the core problem is not in overabundance or lack of chemicals in the brain, but a broken neural circuit. Medication masks the symptoms of mental illness, but does nothing to repair the circuitry of the brain. Etkin believes Transcranial Magnetic Stimulation (TMS) combined with other therapies can actually repair the brain.
I wrote about TMS two years ago, when exploring TMS as an option if I ever encountered serious depression again. Odds are I will. People who have had two major depressive episodes have about an 80% chance of recurrence. I’ve had three. With steady attention to maintaining my mental health, it’s been over 8 years since my last relapse. If I do relapse, I know electroconvulsive therapy (ECT) works for me, but I'm always on the hunt for less invasive forms of treatment. Etkin’s research gives me hope that better solutions are within reach.
TMS uses magnets to stimulate the brain. The patient sits in what looks like a dentist’s chair, and the magnets (which are typically in a figure 8 shape) are placed on the side of the head. Etkin uses fMRI in conjunction with TMS, along with EEG cap to pinpoint the location of the brain that needs stimulation. This video gives a visual of the process. Stanford’s interdisciplinary NeuroCircuit group combines expertise from neurology, psychiatry, engineering and physics to improve both the equipment and application of TMS. Using ultrasound and modifying the format and use of magnetic coils, their objective is to stimulate deeper areas of the brain than is possible with TMS equipment currently available.
Today, most TMS patients have sessions for 45 minutes a day, five days a week for about six weeks. Etkin feels these time frames are arbitrary, based more on reasonable office hours than optimum dosage for the brain. Through his research, Etkin plans to push these boundaries to understand the full potential of TMS.
What encouraged me most about Etkin’s research is that it makes conceptual sense. If a neural circuit is broken between the prefrontal cortex (the portion of the brain that allows us to understand consequences, a concept of future and past) and the amygdala (the more primal portion of the brain that controls instinctive action and emotion), it follows that someone with mental illness might continue to act instinctively well after a crisis point has passed. A veteran of combat hears a car backfire and reacts to gunfire. A person who has been assaulted reacts out of fear to a person who happens to look like the assaulter.
Although these are examples of PTS, Etkin believes this concept applies across mental illnesses (e.g., depression, anxiety or schizophrenia). The link to the prefrontal cortex—the portion of the brain that allows one to distinguish that was then, this is now and a new set of circumstances—has been lost. If that neural path can be rebuilt with TMS, the person stands a better chance of long-term recovery.
And is this type of treatment needed? Absolutely. As part of our visit to Stanford, my husband Ken and I attended the western premiere for “Searching for Home: Coming Back from War.” This photo shows film participants Pam Payeur, Founder of Wounded Heroes Program of Maine and mother of army veteran Michael Payeur (featured in the film); director Eric Christiansen; Kenny Bass, USMC veteran and Executive Director of The Battle Buddy Foundation, with Atlas; J R Franklin, Vietnam veteran.This heartbreaking film depicts the stories of veterans from WWII, Korea, Vietnam and Iraq with deep wounds both visible and invisible. Etkin is featured in the film, with a brief mention of his research.
My husband Ken, shown here with Dr. Alan Schatzberg, Stanford Department Psychiatry and Behavioral Sciences, had an observation about the film that stuck with me: “The veterans with physical wounds were able to reach a level of healing with a prosthetic limb or a bike that most of those with PTS just didn’t reach.”
The wounds on the inside, invisible to most, cut deep. Those of us exposed to mental illness know this, acknowledging each other with a psychic handshake if we dare to tip the hand of our experience. Hopefully, with more research like Etkin’s, embarrassment about mental illness will dissipate as it has for breast cancer and heart disease. Imagine a world where bits of light (or lack thereof) in brain scans can pinpoint mental illness as logically and practically as a fracture on an X-ray. My guess is it will never be this easy, but I'm encouraged that talented scientests like Etkin are closing in on better methods to detect illness and treat patients. Perhaps with tools like this, the shame and secrecy associated with mental illness will fade against the bright light of a more direct path to health.
For more information on Julie K. Hersh, Struck by Living or Decidí Vivir, go to the Struck by Living website.