Jamie is a 33-year-old married mother of two who has suffered recurrent episodes of depression since the age of 16. Initially these episodes would respond slowly to psychotherapy and antidepressant medications like fluoxetine (Prosac) and venlafaxine (Effexor). These act by increasing brain chemicals like serotonin and noradrenaline. The depression would resolve only to return a year or two later, requiring an increased dose of medication or a change of medication.
However, over the past 2 years her depression has not gone away. Her psychiatrist has tried increasing medication doses, changing antidepressants, combining antidepressants and even adding antipsychotic medications – all to no avail. Jamie has become increasingly desperate and despairing, and less able to be distracted from her thoughts of suicide.
Her psychiatrist, also increasingly concerned, feels the only option now is electroconvulsive therapy (ECT). Jamie and her family, whose views on this have been formed mainly by films such as One Flew over the Cuckoo’s Nest, are horrified at the thought.
This scenario and ones like it are surprisingly common. Depression affects almost one of five Australians throughout their life and about 6–7% every year. Many of these patients get better with medication and psychotherapy but many don’t: almost one-third won’t get better over a couple of...
