A technician called Sue-Ellen is measuring my skull. She stretches a wetsuit-like cap with little holes in it over my head, and marks two points with a red Sharpie pen. Removing the cap, she gives me two electrical nodes, each inside a salt-soaked sponge. I hold the sponge-nodes to my head: one on the left of my upper forehead, just behind the hairline, and the other lower down on the right-hand side, just above my ear. She then straps a kind of brace onto my head and I withdraw my hands from the sponges. She adjusts it, a little more to the left, a little nudge downwards, and when she’s sure the nodes are in the right spot, she plugs them into a little box behind me, the Neuroconn Edilth Stimulator—where transcranial direct current stimulation (tDCS) originates.
Unfortunately there’s a body-length mirror in this little treatment room at Sydney’s Black Dog Institute, and if I turn my head right just far enough I can see myself. The whole effect is pretty Minority Report. I’m Samantha Morton’s pre-cog. I’m a mental patient. When I pull my hair back in the bathroom afterwards, I see red patches where the nodes were. I then go back to my office and write for the rest of the day. Hardly anybody knows what I’m up to. I do this every day for two months, and then intermittently for the rest of 2013.
I’ve been nuts for twelve years, and I’ve gotten pretty good at it. There are high-functioning alcoholics, high-functioning drug addicts, high-functioning anorexics, and there are high-functioning depressives. I’ve done cognitive behavioural therapy, acceptance commitment therapy, I’ve taken Zoloft, Effexor and so many other psychotropic drugs I’ve forgotten their sci-fi names. I’ve done hypnotherapy, Yoga Nidra, meditation and brewed damiana tea. But looking back, transcranial direct current stimulation (tDCS) was a pretty drastic thing to do, even for me. Upon telling my friend Tiyan recently, she just blinked and said, ‘That’s probably one of the weirdest things anyone has said to me, Lauren.’ I never really thought of it that way, though.
It sounds like electro-convulsive therapy—the heavy-duty treatment made infamous by pop-culture classics such as One Flew over the Cuckoo’s Nest. But it’s not—it’s painless, it doesn’t induce seizures, and the patient remains awake throughout. In opening up and reconnecting the neural pathways, tDCS can go beyond lifting depression: it heightens cognitive functioning, funnels your ability to focus and allows you to learn new things faster, to the point where the United States military is trialling its use in training marksmen. The quick, unconscious noise of the mind is quietened, a crisp lucidity is found. New connections between brain cells are promoted, thoughts become organised and focused. It’s a Tony Robbins motivational talk for your neurons, a futuristic miracle that promises a shiny new subconscious. And it has no known side effects. tDCS became my new medical crush.
Those with the most morbid variety of depression, the terminal kind that can kill its sufferers, are generally either near-catatonic, or highly agitated, underweight insomniacs. For such people tDCS represents a great hope. It can be implemented quickly, without the memory damage of ECT, or the weeks and months that anti-depressants require to kick in, if they kick in at all. This treatment is potentially life-saving because it is immediate, non-invasive and non-addictive. Of course, electrifying brain tissue has its own perils, but as a researcher at a university I have access to scientific journals that are not available to civilians, journals with titles such as Current Psychiatry Reports and Frontiers in Human Neuroscience, and this is what I found: although researchers across neuroscience and psychiatry seem to have a pretty strong idea that tDCS smashes major depressive disorder, they’re not precisely sure why or how and don’t fully understand the details of the neural mechanisms that make it work. They don’t know the optimal frequency at which the brain should be zapped, where exactly the current is best applied, how long the effect of the treatment lasts, whether your brain adjusts to it in the same way that your body adjusts to alcohol, whether those who respond well to tDCS will relapse into the abyss, or the limits to what it can achieve. If this sounds crazy, just consider the fact that we don’t really know how or why antidepressants work either, and that’s because we know surprisingly little about the brain, its function, its relationship to consciousness, the psyche or much at all. Hell, we don’t even know how anaesthetic works, we just know that it does, and we use it all the time.
For how long can you, should you, electrify neural lines? And how long do they stay open? The professor who led the study I took part in—a kind of super researcher who has written more than 300 peer-reviewed articles in her field of neuropsychiatry—told me it’s not clear, which is why Black Dog gives its participants a burst of the treatment every day for a month before tapering off to weekly then fortnightly bursts to maintain and support the treatment.
I came to the conclusion that tDCS was as safe or experimental as the conventional methods used by GPs—who are general doctors with no specific expertise in mental health. If the risk of jolting my brain was unknown, so was the risk of not acting. My last best hope.
After exchanging a few emails with a staff member from Black Dog named Joshua, we arrange to talk on the phone. I hear an exceptionally mild-mannered and softly spoken man, who doesn’t return my ‘how are you?’ but efficiently sets up a meeting for me. Officially an outpatient service of Randwick Hospital, and a part of the University of New South Wales School of Psychiatry, Black Dog looks like any other university office, though one in lockdown mode. I buzz to get through the front doors, sign in, and wait to be fetched. Joshua leads me inside and takes me through a number of mood assessment questionnaires and enquires about my symptoms and previous efforts at treatment. The assessment takes about two hours, and I’m told I can only be recruited if the Black Dog team thinks I might benefit from tDCS, in adherence to the rigorous framework decreed by the university ethics committee.
A few days later Joshua calls and explains how things will go. The study is randomised, triple-blind and sham-controlled. That is, nobody, not even the researchers themselves, know if I’ll receive the real thing or the placebo until after the entire study is over, which may be years, depending on how long it takes to recruit the sufficient number of participants. After a month of initial sham-controlled treatment, every participant is then offered a further month of guaranteed active treatments. I will start with a test to assess my cognitive functioning. Then every day I will come to Black Dog during my lunch hour, buzz in, sign in, then go into a little office and rate my mood for the day out of ten. Then the tDCS will commence and last for half an hour. During that half-hour, I am to keep my eyes open and sit quietly—no phone checking or reading. In an early exercise involving some of the electro-magnetic equipment, Sue-Ellen tells me I have an especially ‘excitable’ brain, one that is responsive and sensitive to exterior cognitive engineering. It’s a great compliment. On the first day of the treatment, she tells me not to use that half-hour to organise my day and to avoid negative thoughts, as there is some suspicion that these things can nullify the efficacy of the therapy. I am to minimise washing my hair on the mornings of the treatment, as the nodes slip around on clean hair, and I am forbidden to start new medications or take benzodiazepines.
After all of my research, all my hope and anticipation, the first click of the tDCS gives me only a very faint buzz, nothing like the first summer dive into salty ocean water described by the technology journalists who’d had a sample burst. No soft stab of adrenaline, no steady drip of caffeine.
I wanted more from it than this. And after that first month, I got it. I realised that for the first month I must have been on the sham treatment, because on day one of month two, when Sue-Ellen flicks the switch on the Edilth, something is different, like when your finger’s slightly damp and you switch a light on, but inside my head. A dentist drilling into a far-back tooth—not painful, just very disconcerting. The feeling reverberates inside my skull and radiates outwards. It makes me squeeze my eyes and grit my teeth a little—definitely a feeling to be endured. I focus intently on that feeling, excluding all other distractions in the hope that my focus will amplify the positive effects. And after about thirty seconds or so, it fades away, though the machine is still running. Sue-Ellen checks the Edilth every ten minutes, and asks, ‘Is everything okay?’ and just before the half-hour elapses, the strength of the buzz increases again and the machine clicks off. It’s all very regimented and scripted, and at the end of each treatment, she asks how I feel: any dizziness, nausea, fatigue? The skull-buzzing sounds horrendous, but it was brief and never painful. I came to love it because I knew that something was happening: maybe this crazy thing would work.
Three days into the second month, something changed. It wasn’t a sudden click or a sharp intake of breath or the first front-porch sting of Sydney’s winter morning air. Something just changed—I got tuned in. I felt a bit brighter, a bit more alert. The fog started clearing. And then it cleared entirely.
I found I was just getting on with stuff—seeing things whole in the clear air. I wasn’t fretting for twenty minutes over which brand of wholegrain crackers to buy in Coles. I was doing all the things you know you should do, but usually don’t. I stopped checking Facebook at work and started cycling twenty kilometres every day. I started eating mountains of kale and free-range eggs and tuna. An unshakably long-term insomniac, I started sleeping eight hours a night. I even wrote my first book. I was better than me, I was normal. The best version of normal.
Undergoing tDCS wasn’t like an evangelical experience. I didn’t see the light or become manic and start working fourteen-hour days. Things just felt right. I was good at my job, and I knew it. I sometimes even introduced myself as a ‘writer’. Yeah! I liked my body. I was dating men rather than obsessing over them. I was a fully functioning human adult with something resembling peace of mind. At the end of the month, I met with the professor. She was positive. Hell, she even seemed genuinely happy for me, repeating her trademark phrase of approval—‘good, good’—after almost all of my responses. Another success story! I would taper off to weekly maintenance treatments for three months, and then fortnightly ones for a further three months.
Around a year after the treatments ended, I noticed one particular change that had stayed with me. My ability to single-mindedly elevate one thing in my field of focus, to crystallise my attention around a specific task, had become so potent it was as if tDCS had turned me into some kind of time lord. I was a demon with time: going harder and swifter in less time, more concentrated and cutting through to the skeletal essence of things.
When I look back to the time before the breakdown—when the tDCS treatment was still going on—I can now see that some pretty odd things had been happening. One morning in the second month of the treatment, I woke up, showered, made my breakfast, packed my lunch, put my bike helmet on … and couldn’t work out how to get to the university. I just couldn’t think about how to go about it. Thousands of options presented themselves to me, but none was self-evidently the correct one. But when things are generally going well, you don’t question the blips.
Ten months after starting the brain-zapping, the good vibes had worn off entirely, and by the end of that month I was sufficiently depressed to qualify for another course of what they call ‘acute daily treatments’, which lasted for the month of December. I trudged in dutifully every day, hopeful of returning to the electricity-induced state of Zen togetherness. But I got nothing. I felt my body powering down. I had three panic attacks a day, six weeks in bed, months of broken sleep, complete and utter confusion. Hadn’t I been proactive? Hadn’t I tried? You are living a fearful life. Nice friends told me it was okay to feel flat, and that they were sure I’d be fine. My GP put me on an alchemic mix of anti-everything medications. Long walks, juices, omega 3s, being very good—nothing helped. Dejected, I ceased the transcranial direct current stimulation. The depression I had experienced before was nothing compared to this. I couldn’t figure out how breakfast worked. No sequence of events formed a linear pattern—milk, fridge, spoon, washing up, muesli, chewing. All the simple movements and decisions that comprise daily life. Nothing made sense. So for five or six months I did a lot of nothing.
Perhaps you are not surprised by this meltdown—passing a low-pulsing electro-magnetic current through your frontal lobe for months on end probably seems pretty rogue. I too began to fear I’d been too cavalier. Eighteen months after commencing the trial, I arranged to meet the professor. After twenty minutes of diplomacy I came out with it: did tDCS cook my brain? Did it jump-start me into an unsustainable Super Lauren? Should an already darting, anxious brain be accelerated like that?
The answers were as vague as I’d expected—a barrage of ‘potentials’ and ‘unlikelies’ deep in science’s grey area. Yes, it is possible to fry the brain, but no, she didn’t think that’s what had happened. No-one else had had this response to the treatment and she doubted my relapse had anything to do with tDCS. It was probably just the natural course my depression was taking, and it seemed that the treatment had been temporarily successful but unable to prize my neural pathways open in the long term.
The professor offered me another month of brain-zapping. I know she meant well. I admit I miss my tDCS glory days when I had a sense of what I could do, a grasp of my potential, if only I could get on with things and live as if I were alive. I thanked the professor and left Black Dog as the blue dark of evening came down. In the months after the treatment I came to notice a bright, white light that flashed at the periphery of my vision, and especially on the right-hand side. I saw it maybe a dozen times. Sometimes I think I still see it. But I can’t be sure.