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Today, people already know that the constant state of depressed mood can interfere with normal life. Once upon a time, a visit to a psychiatrist was something embarrassing, he was visited as a last resort – says prof. dr. hab. Joanna Rymaszewska in conversation with Edyta Brzozowska. A psychiatric ward has opened in Wrocław, where depression, bipolar disorder, anorexia and many other diseases and disorders are treated with the most modern method – transcranial stimulation.
- We put a coil on the surface of the head, resembling a large shower head, which emits a magnetic field. We affect the tissue reaching up to 5 centimeters deep into the brain. We stimulate a specific area – for example, in depression, part of the brain is quiet, not working much
- Electric shock is an effective method, with almost no side effects that can be caused by drugs and dietary supplements that patients overuse
- At the Psychiatry Clinic of the University Teaching Hospital in Wrocław, a psychiatric ward has opened, in which depression, bipolar disorder, anorexia and many other disorders are treated with the most modern method – transcranial stimulation of the brain
- It is not known where the drug resistance comes from. There are many factors: from external – family or professional situation – to genetic determinants. It also happens that drugs work only to a limited extent: they can improve sleep, appetite, reduce pain or anxiety in the patient. But still a person has a depressed mood, he lacks the joy of life
Edyta Brzozowska: Is pharmacological treatment of mental disorders a thing of the past?
Prof. dr. hab. Joanna Rymaszewska: Due to the fact that we are a university hospital, and therefore a research center, we can introduce new methods of treatment. Those that are not yet common in Poland. In the new ward, we will have the opportunity to test the effectiveness of innovative therapies to overcome recurrent depression, obsessive-compulsive disorder and bipolar disorder in patients showing drug resistance. There are many patients for whom drug therapy is ineffective, and electroconvulsive treatment is also ineffective. Some statistics show that drug-resistant patients can be as high as 25 percent.
Where does drug resistance come from?
This is not fully known. There are many factors: from external – family or professional situation – to genetic determinants. It also happens that drugs work only to a limited extent: they can improve sleep, appetite, reduce pain or anxiety in the patient. But still a person has a depressed mood, he lacks the joy of life. Then you have to use other methods.
What?
One of such therapies, recognized by world authorities in the field of treating mental disorders and carried out in close cooperation with neurosurgeons, is deep stimulation of the brain by electrodes implanted in the subcortical structures of the brain. It is normally used in patients with Parkinson’s disease for whom the drugs are not working adequately. Another method that can be used in an outpatient setting is transcranial magnetic stimulation. The sick person comes, lies down in the chair – such as at the beautician’s, and for half an hour or less, but more intensively – is subjected to brain stimulation.
Is it a complicated procedure?
We use a special device with neuronavigation, which gives a very detailed picture of the brain. Thanks to this, we can determine where the stimulation should be carried out, for example in the case of depression it is the prefrontal cortex. Then, to the surface of the head, we put a coil resembling a large shower head that emits a magnetic field. It, in turn, affects the brain tissue reaching up to 5 centimeters deep into the brain. In this way, a specific area of the brain is stimulated – for example, in the case of depression, part of the brain is quiet, not working much. The generated electromagnetic field causes better work of neurons, and as a result – more efficient functioning of the brain.
What other mental disorders can be treated with such stimulation?
For example, eating disorders: anorexia and bulimia. We will also test this method in the states of mild cognitive deficits. In other words, the stimulation will apply to patients with a tendency to forget, which can develop into dementia. Such a condition is bothersome for patients, and stimulation combined with appropriate, systematic exercises can give good results.
Transcranial stimulation is a new method on a national scale?
Yes. The first attempts at this type of stimulation were carried out years ago in Krakow, but the equipment was then very imperfect, and the results were inconclusive. Recently, there has been enormous technological progress in medical equipment, so our equipment allows for much better results. I know that several university centers in Poland are already planning to purchase this equipment.
Have you had the opportunity to observe the spectacular effects of treatment with transcranial stimulation?
We are only just starting to implement this method, so it is difficult to talk about such cases at the moment. However, together with the doctors, we learned stimulation and practiced it on ourselves, in training courses in the Netherlands, where transcranial stimulation is the standard treatment. The results of the therapy there are very promising, so I hope that we will be able to boast of such results soon.
Will a brain stimulation device replace electroshock? They are notoriously notorious and are often associated with the barbaric method of turning a human being almost into a plant.
Completely wrong. Electric shock is a very effective method used in psychiatry, in addition, with almost no side effects that can be caused by drugs and dietary supplements that patients overuse. Today, electroshock is different from those used in the old days. It is similar, for example, with XNUMXth-century surgery: which was carried out without anesthesia and antiseptics. Or dentistry, when in ancient times teeth were torn at a blacksmith with unsterilized pliers. Electric shock in psychiatry is sometimes necessary, it saves people’s lives and helps to function normally. This is a standard, very good method, safely performed in cooperation with an anesthesiologist. We use it to treat drug-resistant depression and schizophrenia – especially catatonic, when pharmacological action does not help.
How do you assess the mental condition of Poles?
Statistics show that they use psychiatrists’ advice more often than in the past. More and more patients are treated both in hospitals and private offices. Part of this is due to the greater awareness of people who realize that they need to go to a specialist for help because they will not be able to cope on their own. They know that a constant state of depressed mood can interfere with normal life and functioning. In the past, a visit to a psychiatrist was something embarrassing, you only went to him as a last resort. Fortunately, that has changed today.
* Prof. dr. hab. Joanna Rymaszewska – dean of the Faculty of Medicine of Postgraduate Education; head of the Department and Clinic of Psychiatry at the Medical University in Wrocław; member of the Advisory Board of the European Society of Psychosomatic Medicine, European Psychiatric Association, Polish Psychiatric Association