Effective therapy for depression difficult to access in Canada
A non-drug therapy used to treat anxiety and depression has been proven to be beneficial, doctors and patients say – but for Nova Scotian Susan Wood, getting that help was a significant challenge.
Wood‘s depression left her in a state she describes as “absolute exhaustion,” in which she estimates that she was functioning at 40 per cent of her normal level.
“[It] took a great amount of effort just to get two feet on the floor and move forward with each little step in the day,” Wood said in an interview.
Various treatments failed to improve Wood’s situation. Then she heard about an innovative treatment called repetitive transcranial magnetic stimulation, or rTMS.
To her dismay, she discovered it was not available in her community of Fauxburg, N.S. In fact, there was no way to access it anywhere in Atlantic Canada. (One clinic has since opened in Halifax.)
The rTMS therapy involves sending magnetic pulses to targeted regions of patients’ brains in order to stimulate neurons and change the functioning of brain circuits.
It is non-invasive and non-pharmaceutical, and has been proven to be a highly effective treatment for some people with depression who do not take medications. Studies have suggested that half of patients got a 50 per cent improvement in their symptoms and about one-third of rTMS patients reported that their depression went into remission for at least six months.
The technique is approved for use in Canada. However, only about a dozen clinics offer it and most provincial and territorial health-care systems do not cover the cost of the therapy.
The exceptions are Quebec, Saskatchewan and Yukon. This is in contrast to the United States, where there are more than 1,300 clinics and rTMS is part of every state’s Medicare program for seniors.
The cost of a full course of rTMS treatment can reach as high as $1,500 – but for Wood, the bigger issue was the time commitment.
Patients taking rTMS typically have to undergo 20 to 30 sessions of the therapy within four to six weeks. Wood was able to get her timeframe reduced to three weeks – but the closest clinic she found that would take her was in Toronto.
“It was quite a task to get there and a significant amount of expense for me to stay there,” she said.
“I had no other choice … because I really had no hope. I really felt I didn’t have quality of life and I really was having trouble seeing the future for myself.”
The sessions used to take up to an hour each, but recent advancements based on Canadian research have been able to cut that time to approximately three minutes.
Wood pegs her eighth rTMS session as when she began to see that future once again. Her head started to clear. As she kept returning for more treatments, she continued to feel better and better. When not at the clinic, she was more eager to go for a walk or talk to her friends than she had been in years.
“It’s given me my life back,” she said.
“It has given me hope, where I was not seeing any hope, it allowed me to see a future for myself where I wasn’t seeing a future for myself anymore “
Dr. Jonathan Downar is the co-director of the rTMS clinic at Toronto’s University Health Network, where Wood received her treatments. He says he’s concerned that geography seems to play such a big role in whether rTMS is a feasible option for people who have depression.
“You have pretty good access to the treatment in downtown Toronto,” he said.
“If you live in Peterborough or Timmins or Kapuskasing or Red Deer … then it’s a lot more challenging.
“I am contacted by patients all over Canada and sometimes internationallyasking if they can fly up here for rTMS. I am not against people flying here for rTMS but it’s really not a practical solution.”
Downar is attempting to create a rTMS kit that can be administered in a patient’s home, potentially making the therapy even easier to access. He estimates that the cost of this treatment could be as low as $2.25 per patient per day.
In the meantime Wood has become an advocate, sharing her story so patients across Canada may also get access to the life-altering treatment.
“I would like other people to have the opportunity that I had because for me personally it had such a profound effect (…) and it can help a lot of people,” she said.