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Batteries Not Included

Columbia-Presbyterian's Dr. Harold Sackeim doesn't shock easily.

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Though it bears little resemblance these days to the jolts received by Jack Nicholson in One Flew Over the Cuckoo's Nest, the mere mention of shock treatment still makes most people's hair stand on end. But electroconvulsive therapy, or ECT, has advanced far enough that a surgeon general's report released this week endorses it as "a safe and effective treatment for depression." Before strapping themselves in, however, New Yorkers may want to stop off at Columbia-Presbyterian Medical Center, where the world's top ECT expert is conducting research into the next generation of high-tech anti-depression therapy.

"We're working on a way to no longer use electricity at all but to use very focused magnetic fields to target particular areas of the brain for seizure induction," says Dr. Harold Sackeim. Transcranial magnetic stimulation, or TMS, has been around for years, but only as a way to study the brain. As a treatment, it may have certain advantages over traditional ECT, in which patients are sedated beforehand and are often disoriented afterward. "When you get nonconvulsive TMS," Sackeim says, "you can basically sit in a chair and read a newspaper."

Dr. Sarah Lisanby, who leads Sackeim's TMS research team on 168th Street, is trying out the treatment on Columbia-Presbyterian's primate population, and human trials are due to begin next year. With ECT, "electricity gets smeared and degraded by the resistance of the scalp and skull," says Lisanby, her gray-green eyes flashing with excitement as she sits in Sackeim's corner office overlooking the Hudson River. "With TMS, you get better control." You also avoid some of ECT's more disturbing potential side effects, such as transient (and sometimes permanent) memory loss and, on extremely rare occasions, death.

Sackeim and Lisanby recently took off for Acapulco -- but not to test the effects of sunshine and tequila on depression. Sackeim is presenting a new study this week to the American College of Neuropsychopharmacology. That study involves something called vagus-nerve stimulation, or VNS, a distant cousin of electroshock, in which an electrode implanted in the chest wall stimulates the vagus nerve in the neck every five minutes or so, 24 hours a day. "It's pretty wild," says Sackeim. Already approved for use in treatment-resistant epilepsy patients, VNS, according to the new study, may also be useful in treating extreme depression. A study designed to win FDA approval for VNS as a treatment for depression already has the initial go-ahead.

Though some patient-advocacy groups are up in arms over the surgeon general's report, ECT is now enjoying greater acceptance among doctors than it has in decades. But even if you're sure you'd be able to find your way back to the office after a few juicings a week, consider that most doctors still prescribe the treatment only for the most severe or urgent cases, or those in which psychotropic medications have proved ineffective. Sackeim's new treatments may dodge ECT's side effects, but he stands firmly behind the therapy as it exists today. He replies in the negative when asked whether he has undergone the treatment himself. "But I would," he adds after a pause, "if I needed it."


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