The Academic Exchange Talk about your research through the Center for Complementary and Alternative Medicine.

Professor William McDonald We’re testing transcranial magnetic stimulation (TMS) as a replacement for electroshock therapy. Electroshock therapy is highly effective in the small group of patients who don’t respond to any of the other treatments for depression, but there’s a tremendous cost to it. It’s invasive, there are side effects such as memory problems, and there’s still some social stigma.
tms applies high-powered magnets outside the skull, over an area of the brain called the left prefrontal cortex. If you take that small group of depressed patients who don’t respond to other treatments, about 90 percent respond to electroshock, but a sizeable number—about 50 percent—respond just as well to tms. The advantage is that there’s no anesthesia, and it takes about thirty minutes. It’s much less invasive. You can do the treatments with a minimal amount of training. And I think from the point of view of the patient, there’s no stigma.

AE Are there side effects?

WM There appear to be no appreciable side effects. Being able to target the problem area is an advantage for treatment and for understanding depression. It will also help our understanding of what part of the brain is affected. Electroshock and antidepressants go through the whole brain and have a number of side effects. Even with good, safe medicines like Prozac, 40 percent of people lose their sex drives.

It’s important to understand that depression is not one disorder. Some depressed people are suicidal, some psychotic. Some overeat; some don’t eat at all. About 50 percent of people with Parkinson’s get depressed. If you take 20 depressed Parkinson’s patients, they may have different levels of severity, but the symptoms are very similar. They almost always lose their appetite, lose their sleep, and have feelings of guilt, but they very rarely have suicidal thoughts.

In fact, there seem to be similar mechanisms at work in Parkinson’s and depression. In some ways, depression is a model for Parkinson’s disease. Our theory is that if you treat the depression, the Parkinson’s will get better also because they’re involved with the same general mechanisms. So you can help both by treating one.

But much depression isn’t related to Parkinson’s. Mood and anxiety disorders are just very prevalent disorders that are way under-diagnosed and way under-treated. The sense in the general public is that everybody’s on Prozac. That’s not true at all. It depends very much on social class and race. These treatments are pretty much reserved for people who are seeing their doctors regularly—people who even have a doctor. Those people who are poor and who have much less social support are much less likely to see a doctor and probably more likely to get depressed because of stressors.

AE What would you like to see ideally from these treatments fifteen years down the road?

WM In a perfect world of research, we could decrease the stigma of these disorders, so people would treat this disease the same way they treat heart disease. The second thing is that we would really start treating people at a level that’s appropriate. That we start treating poor people, treating people who lack the social support.

I also think we need to stop creating depression. Because years ago, when we didn’t have medicines, everybody looked at social support and what sorts of networks are out there for people. Now we’ve gone in the opposite direction. In a perfect world, we would figure out how to provide a support network for these people beyond Prozac. I’d like to think that we’ve figured out some way of providing support networks to care for our elderly and keep them in the community.

AE Complementary medicine also carries a stigma in medical culture, like depression does in our general culture.

WM Well, some of that is deserved. An NIH study that found that St. John’s wort was no more effective than a placebo. But everybody assumes that because it’s “alternative,” it’s safe and effective. The snake-oil salesmen of the 1930s were doing a kind of complementary medicine. And now people once again think natural is safe.

The issue for me is, are people getting taken advantage of? People get the idea that it’s going to be cheap, safe, easy to take, no interactions—but that’s just not the case. But, on the other hand, we are passing by a lot of natural things that could be helpful.