“I was ruminating terrible, ugly thoughts about myself. I felt the only way out was suicide because I couldn’t control it. I wasn’t hearing that people were loving me. All I could hear was negative chatter. It was everything, including ‘You’re ugly, you’re stupid. I don’t know why your husband married you. He’d be happy if you were gone. My kids wouldn’t care.’ It was just awful.”
Deirdre Lehman can vividly recall the thoughts going through her mind in late June 2018. That day her mental health took a drastic turn, and she slipped into a severe depression. Within five days she was suicidal. Her family had to hide all sharp items so she couldn’t hurt herself and slide furniture in front of the door so she couldn’t run outside. “The mania broke through, and I wanted to run through the streets with my pajamas on,” she says. “That particular episode was considered rapid cycling because all of a sudden I went down and was quiet and depressed right after I wanted to run down the street.”
Deirdre was already under the care of a psychiatrist, who, fortunately, knew about a small clinical trial that Dr. Nolan Williams, associate professor of Psychiatry and Behavioral Sciences and director of the Stanford Brain Stimulation Lab in Palo Alto, California, was running to treat severe depression using SAINT™ therapy (Stanford Accelerated Intelligent Neuromodulation Therapy). The SAINT™ Neuromodulation System uses a specialized magnetic resonance imaging (MRI) of brain activity to identify the most strongly connected portions of the left dorsolateral prefrontal cortex (L-DLPFC), an area of the brain, with respect to the subgenual anterior cingulate cortex (sgACC), a deeper subregion of the brain. In people who have severe depression, the L-DLPFC is underactive and the sgACC is overactive, which impairs their ability to stop or block out inward negative thoughts. Clinicians use both structural MRI and resting-state functional connectivity MRI to find the precise spot where the DLPFC is connected to the deeper network and locate the specific treatment target.
The SAINT Neuromodulation System uses a targeted and fast-acting approach. The system’s magnetic pulses are designed to replicate how the brain communicates with itself, and the repetition of the pulses teaches the brain how to maintain its balance. Patients treated with SAINT undergo a 5-day course of high-dose intermittent theta burst stimulation that delivers 1,800 pulses per session. They have 10 sessions per day with a 50-minute interval between each session. Follow-up or maintenance treatments may be less and are tailored to the returning patient’s needs.
Within a day of being treated with SAINT, Deirdre says her brain felt the calmest it had been since she was 16. “I remember looking at my husband Clark and asking, ‘Is this how your brain works?’” she says. “I remember him responding, ‘Yes.’” “In one day, she went from suicidal to fine,” says Clark. He recalls Dr. Williams’ description of what was happening in Deirdre’s brain: The brain, if it’s operating normally, can respond to negative thoughts with a positive or counteractive thought. In a depressed person, the rational, logical side gets tired or becomes incapable of responding to the speed of negative creative ideation, and it shuts down.
Fatigue was the main side effect of Deirdre’s treatment, which is to be expected. “Your brain is exercising. They’re bumping up the energy and overworking the physiological part of the brain, which creates some fatigue,” says Clark.
It’s lifesaving and life-changing. It’s not a cure, it’s a therapy, and it’s a much more effective way of treating the brain compared to any kind of medication.
At 16, Deirdrewould get depressed and wouldn’t get out of bed for one day. The next day her symptoms disappeared, but it would follow a period where she was really wound up, talking quickly, then sitting down and jamming through her homework. Then the next day or two, I’d get this weird depression and nobody could figure it out. I just thought, ‘That’s how I am,’” she says.
Her symptoms reappeared in college. After college, things settled down. She married Clark and they had two daughters. She had postpartum depression after each pregnancy. “I was severely depressed. I couldn’t seem to attach to them as babies. A really great gynecologist diagnosed me with postpartum depression, and I went on Prozac, which solved the postpartum depression,” she says.
Her symptoms died down again for a few years, but in her 40s, she suffered from severe depression. She had a psychotic break in 2005, but her psychiatrist, fearing she would get worse in a psychiatric ward, advocated that she stay home, surrounded by family to take care of her. “I’m very fortunate because I have an amazing support network that includes my husband, my mom, my dad, my two sisters, and my two brothers,” she says. “They learned how to help me to manage my depression.” Deirdre was officially diagnosed with bipolar disorder and depression in 2005. From 2005 to 2018, Deirdre says, “I was totally stable. No hypomania, no depression. The minute my psychiatrist would see a hint of anything, she’d adjust my meds. Fortunately, the medications really helped, and I didn’t have severe side effects. The event in 2018 was the worst depressive experience of Deirdre’s life. She experienced the exact same type of episode in January 2020, where she spiraled quickly into a severe depression. She contacted Dr. Williams immediately and she received another course of treatment. “It was miraculous. The hardest thing for me was to wrap my head around the fact that I had been so depressed, and then I felt fine,” she says.
Fortunately, she hasn’t had any major episodes since. If she starts to feel low, she goes to see Dr. David Carreon, a colleague of Dr. Williams, to get a maintenance treatment. So far, the maintenance treatments are generally every eight months. She considers SAINT part of her mental healthcare regimen, along with taking medication and seeing her psychiatrist regularly.
Not a Choice
Deirdre is a champion of SAINT. “It’s lifesaving and life-changing. It’s not a cure, it’s a therapy, and it’s a much more effective way of treating the brain compared to any kind of medication,” she says. She really wants physicians, psychiatrists and the general public to be aware that SAINT is an effective, life-saving therapy. “Doctors, people suffering from severe depression and their families need to know about SAINT and that it really is effective. The amount of time someone’s been depressed doesn’t really matter—it works,” she says.
She’s thankful and feels fortunate to have had the support of her husband, daughters and other family members through her mental healthcare journey. “Deirdre now knows that it’s not a choice. She’s not choosing to be depressed. It’s physiology. That realization was so important,” he says. “SAINT is also a safety net, if you will,” she says. “I think that contributes to the stability, knowing that if you are depressed, you can beat the suicide cycle. You can feel calm.”
New Clinical Trial for Severe Depression
A new open label optimization (OLO) clinical trial to study the SAINT Neuromodulation System for treating MDD is currently enrolling. To learn more, please visit https://www.magnusmed.com/clinical-trials/.