Sarah H. Lisanby (b. ca 1965) [1] is an American psychiatrist who studies the use of neurostimulation devices to treat mental illness. Since 2015 she has directed the division of the National Institute of Mental Health (NIMH) working on translational research. [2]
Lisanby received dual undergraduate degrees in mathematics and psychology from Duke University in 1987 and received her MD there as well. She completed a residency in psychiatry, serving as chief resident. [2] While she was a resident, she witnessed a woman with catatonic major depressive disorder undergo a dramatic remission after being treated with electroconvulsive therapy (ECT) and this set the course for the rest of her career. [1]
After she graduated she undertook a fellowship at the New York Psychiatric Institute under Harold A. Sackeim, who had been doing research on ways to reduce the adverse effects of ECT on memory by using magnets to induce seizures in the brain instead of delivering electricity directly, a therapeutic mode called magnetic seizure therapy (MST). [1] He asked her to work on developing a prototype that could do this, and by 2000 she and a team of collaborators had prepared one, and it was tested on a person in Switzerland. [1] She also started investigating transcranial magnetic stimulation with Sackheim at the institute. [3]
In 2005 she founded the Division of Brain Stimulation at Columbia University. [1]
When Kitty Dukakis published her book about ECT in 2006 and in her subsequent advocacy for ECT, Lisanby has been asked to provide medical commentary on ECT. [4] [5]
By 2010 Lisanby had led two scientific societies focused on neurostimulation and had published 150 papers; at that time she moved back to Duke. [1] In 2013 she was involved in some of the early clinical studies of transcranial direct current stimulation. [6] [7]
In 2015 she was recruited to NIMH by Thomas Insel. [1]
In much of her career she has advocated in public, in the scientific community, in the medical community, and at the FDA to remove the stigma from ECT and to develop MST and other neurostimulation methods. [1]
Lisanby was interviewed in 2018 by Anderson Cooper for the CBS television show 60 Minutes as an expert on MST. [8]
Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a psychiatric treatment where a generalized seizure is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple or from front to back of one side of the head. However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil connected to the scalp. The stimulator generates a changing electric current within the coil which creates a varying magnetic field, inducing a current within a region in the brain itself.
Deep brain stimulation (DBS) is a surgical procedure that implants a neurostimulator and electrodes which sends electrical impulses to specified targets in the brain responsible for movement control. The treatment is designed for a range of movement disorders such as Parkinson's disease, essential tremor, and dystonia, as well as for certain neuropsychiatric conditions like obsessive-compulsive disorder (OCD) and epilepsy. The exact mechanisms of DBS are complex and not entirely clear, but it is known to modify brain activity in a structured way.
Cranial electrotherapy stimulation (CES) is a form of neurostimulation that delivers a small, pulsed, alternating current via electrodes on the head. CES is used with the intention of treating a variety of conditions such as anxiety, depression and insomnia. CES has been suggested as a possible treatment for headaches, fibromyalgia, smoking cessation, and opiate withdrawal, but there is little evidence of effectiveness for many of these conditions and the evidence for use in acute depression is not sufficient to justify it.
Katharine "Kitty" Dukakis is an American author. She is married to former Massachusetts governor Michael Dukakis.
Peter Roger Breggin is an American psychiatrist and critic of shock treatment and psychiatric medication and COVID-19 response. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with psychotherapy, education, empathy, love, and broader human services.
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy, cluster headaches, treatment-resistant depression and stroke rehabilitation.
Neurohacking is a subclass of biohacking, focused specifically on the brain. Neurohackers seek to better themselves or others by “hacking the brain” to improve reflexes, learn faster, or treat psychological disorders. The modern neurohacking movement has been around since the 1980s. However, herbal supplements have been used to increase brain function for hundreds of years. After a brief period marked by a lack of research in the area, neurohacking started regaining interest in the early 2000s. Currently, most neurohacking is performed via do-it-yourself (DIY) methods by in-home users.
Transcranial direct current stimulation (tDCS) is a form of neuromodulation that uses constant, low direct current delivered via electrodes on the head. It was originally developed to help patients with brain injuries or neuropsychiatric conditions such as major depressive disorder. It can be contrasted with cranial electrotherapy stimulation, which generally uses alternating current the same way, as well as transcranial magnetic stimulation.
Responsive neurostimulation device is a medical device that senses changes in a person's body and uses neurostimulation to respond in the treatment of disease. The FDA has approved devices for use in the United States in the treatment of epileptic seizures and chronic pain conditions. Devices are being studied for use in the treatment of essential tremor, Parkinson's disease, Tourette's syndrome, depression, obesity, and post-traumatic stress disorder.
Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.
Linda Andre was an American psychiatric survivor activist and writer, living in New York City, who was the director of the Committee for Truth in Psychiatry (CTIP), an organization founded by Marilyn Rice in 1984 to encourage the U.S. Food and Drug Administration (FDA) to regulate electroconvulsive therapy (ECT) machines.
Magnetic seizure therapy (MST) is a proposed form of electrotherapy and electrical brain stimulation. It is currently being investigated for the treatment of major depressive disorder, treatment-resistant depression (TRD), bipolar depression, schizophrenia and obsessive-compulsive disorder. MST is stated to work by inducing seizures via magnetic fields, in contrast to ECT which does so using alternating electric currents. Additionally, MST works in a more concentrated fashion than ECT, thus able to create a seizure with less of a total electric charge. In contrast to (r)TMS, the stimulation rates are higher resulting in more energy transfer. Currently it is thought that MST works in patients with major depressive disorder by activating the connection between the subgenual anterior cingulate cortex and the parietal cortex.
Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.
Mark S. George is a Distinguished University Professor of psychiatry, radiology and neurosciences and is the director of the Medical University of South Carolina (MUSC) Center for Advanced Imaging Research as well as the Brain Stimulation Laboratory. As of June 2020, his research has been cited over 47,000 times, with an h-index of 113 and i-10 index of 404.
Neuromodulation is "the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body". It is carried out to normalize – or modulate – nervous tissue function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space. Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired. The most clinical experience has been with electrical stimulation.
David John Impastato was an American neuropsychiatrist who pioneered the use of electroconvulsive therapy (ECT) in the United States. A treatment for mental illness initially called "electroshock," ECT was developed in 1937 by Dr. Ugo Cerletti and Lucio Bini, working in Rome. Impastato has been credited with the earliest documented use of the revolutionary method in North America, administered in early 1940 to a schizophrenic female patient in New York City. Soon after, he and colleague Dr. Renato Almansi completed the first case study of ECT to appear in a U.S. publication. Impastato spent the next four decades refining the technique, gaining recognition as one of its most authoritative spokesmen. He taught, lectured widely and published over fifty articles on his work. He called on ECT practitioners to observe the strictest protocols of patient safety, countered resistance to ECT from both the medical and cultural establishments, and met later challenges to electroconvulsive therapy from developments in psychopharmacology. Impastato would live to see ECT recommended by the American Psychiatric Association for a distinct core of intractable mental disorders. The U.S. Food and Drug Administration took longer to respond to the treatment's potential. But in 2016 the FDA drafted guidelines for ECT similar to those of the APA, as well as proposing regulations for treatment with Class II and Class III devices. Though still not free of controversy, electroconvulsive therapy is the treatment of choice for an estimated 100,000 patients a year in the United States.
Abraham Zangen is an Israeli professor of neuroscience, head of the brain stimulation and behavior lab and chair of the psychobiology brain program at Ben-Gurion University of the Negev (BGU).
Non-invasive cerebellar stimulation is the application of non-invasive neurostimulation techniques on the cerebellum to modify its electrical activity. Techniques such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) can be used. The cerebellum is a high potential target for neuromodulation of neurological and psychiatric disorders due to the high density of neurons in its superficial layer, its electrical properties, and its participation in numerous closed-loop circuits involved in motor, cognitive, and emotional functions.
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