Q: What is new with EST and Magnetic Resonance Treatment and BipolarII?
Anything promising ?
Dear Ms. F' --
As though you were a "plant" in the audience, asking the leading
question at just the right moment, there are a couple of "new"
1. EST -- a new acronym? Or mean you ECT,
for electroconvulsive therapy, where nope there's no new news specific to
Bipolar II. The only "new" thing I've heard there is an article
indicating new concerns about maintenance ECT (where a person gets repeated
single ECT sessions, usually about a month apart, to maintain an improvement
that ECT yields but which cannot be maintained using
psychotherapy/medications/exercise but instead only ECT). The new concern
is that repeated ECT leads to some lasting cognitive impairment
unlike the short-term impairment following each session which typically resolves
within weeks. Thus there is this small new bit of data to further spur
interest -- mine, anyway -- in the magnetic approaches.
In repetitive Transcranial Magnetic Stimulation (rTMS),
the magnet used is as strong as that used for MRI studies, 1-2 tesla -- in other
words, this is nothing at all like a magnet someone might try to sell over the
internet to put around your wrist! For a few more references on the ECT
and rTMS, read
letter on this site.
Perhaps you know of a new acronym, but the only other
treatment I know of that's new in this area is called magnetic seizure
therapy. Basically it's a cross between ECT and TMS, where a seizure is
induced using a TMS magnet instead of using electrical current. In one
there was less memory impairment (which is the main problem in terms of ECT side
2. There are two remaining magnet manufacturers
in the world, apparently; the third one went out of business waiting for FDA
approval after they submitted what they thought would gain that approval and
were turned down. I've had some interesting conversations recently with a
researcher who's been studying the magnet for years, and the head of one of the
remaining magnet-producing companies. There are some pretty complex policy
decision-making processes going on and it sounded to me as though waiting for
FDA approval of this device may be a long wait even yet. There is a
European company selling the device, and it is apparently being used fairly
widely in Europe and Canada. One of the main research groups studying it
is in Israel (may there be peace among Muslims, Christians, and Jews in our
In the last month I've been studying what it would take
to get underway with a magnet in the U.S. as an "off-label" treatment,
just as we use many
off-label. This is proving to be very complicated but is not looking
impossible yet. There should be some news in this respect soon.
However, anything that looked like "advertising" of the magnet
treatment is not allowed under the FDA "labeling" process, just as any
drug that is used "off-label" cannot be advertised by its
manufacturers for that purpose (you should see how the companies try to wiggle
around that one!). So if I was ever to get underway with the magnet
treatment in Corvallis, I could not do anything that looked like advertising of
same -- but I could respond to questions, just as to yours now. If
something actually happens, I'll try in some fashion to indicate that more
detailed questions would be acceptable (there's no point in that just
As you can gather, I am convinced myself from the
literature that the magnet is sufficiently safe and sufficiently effective to
warrant it's use when more conventional treatments have not been successful.
It is not something to be used before treatments we currently have more
experience with. But when people need an alternative to those, and would
be considering ECT for example, I think rTMS is a tool we need to have
available. I've been working on this recently for a couple of patients who
are in just this position, and I wish it was ready right now.
Published March, 2003