New depression therapy should be covered in N.L. say doctor, retired nurse

A retired nurse from St. John's and a doctor in Toronto are arguing that a new treatment for depression should be covered by the medical care plan in Newfoundland and Labrador.

"I would ask them to please have a look at this treatment because so many lives depend on it," said Trudy Bradbury, who worked as a nurse for 34 years, and suffered from depression herself.

"I know how it feels. I experienced it 13 years ago," said Bradbury.

"I was one of the lucky ones. I responded to medication and was able to return to work within a few weeks."

She said about one-third of people with depression do not respond to drugs, and now she's asking the provincial government to pay for a different kind of therapy.

Repetitive transcranial magnetic stimulation (RTMS) is a treatment that was approved by Health Canada in 2002, and is already covered in Quebec and Saskatchewan.

Re-setting the circuits

Dr. Jonathan Downar, a Toronto psychiatrist who specializes in brain stimulation, said RTMS is effective, with two out of every three patients showing complete or partial improvement.

"It's a technology that was developed in the 1980s and 90s, where you can stimulate the brain without having to open anything up. So it uses a powerful focused magnetic field to directly activate the neurons of the brain," he said.

​Downar, who offers RTMS at a private clinic in Toronto, says the treatment costs between $1,500 and $3,000, with patients needing 20 to 30 daily sessions.

"RTMS, it's like exercise, it isn't like surgery," said Downar. 

"So when you apply the stimulations, it's like re-setting the circuits. It's like when you re-set your watch, after a few months it will gradually creep back to the way it was again."

Patients need occasional booster sessions, he said, but with proper treatment can stay well for a long time.

"My message to the Newfoundland government is please focus on the new technology that's out there," said Trudy Bradbury, who is motivated now by the depression of someone close to her.

She said the cost of running a treatment program in this province, and covering it under MCP is worth it, because patients will be able to go back to work, and lead productive lives.

It's also an alternative to electroconvulsive (shock) therapy, which has side effects like the loss of short-term memory.

Cost vs benefit

Jonathan Downar said the cost of RTMS is coming down, with research on how to shorten treatments.

He also said it also provides access to care within weeks of being diagnosed with a mental illness.

"We will never have enough psychotherapists do one-on-one therapy for patients," he said.

"So we have to figure out a way to use our existing supply of physicians and other mental health workers to see larger numbers of people, while preserving quality treatment ... to provide good psychiatric care for everybody who needs it, not just for the lucky ones who make it through the wait lists."

Post-traumatic stress disorders and other conditions could also be treated with RTMS, said Downar.

"It's being explored for addiction to tobacco and to alcohol and to other substances. And it's also being used in some cases for OCD and eating disorders."

Downar said the magnetic stimulation therapy should soon be approved for funding in Ontario. Alberta is also considering it, but in Atlantic Canada the only facility is at Dalhousie University.

Bradbury said she met with health officials in the Paul Davis government to make her pitch, but got no commitment.