Why Do Current Treatments Work?
What do talking, chemicals, electricity, magnetic fields, and brain surgery have in common? They are all evidence-based treatments for mental disorders! So, why do they work? They all impact metabolism and mitochondria.
I’ve already addressed medications and psychotherapy in earlier chapters. Now, I’d like to briefly explain how I think about these other treatments in the context of the brain energy theory. If this theory is true, there should be plausible explanations for why these treatments work, at least for some people.
ECT and TMS
Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are effective interventions for a wide variety of mental disorders. For some conditions, such as severe depression or catatonia, ECT is considered the gold standard and most effective treatment that we have available. Why do they work? The field doesn’t currently offer a comprehensive explanation. Changes in neurotransmitter levels and hormones are thought to play a role, as well as increased neuroplasticity. The brain energy theory offers one comprehensive explanation.
Electricity from ECT and electromagnetic energy from TMS deliver energy directly to the brain. There’s probably no better example of a treatment being related to “brain energy.” This energy stimulates mitochondria, and in turn, mitochondrial biogenesis. When we push ourselves in exercise, the body senses that it needs more capacity, so it produces more mitochondria to deliver this capacity. ECT and TMS appear to do the same thing. This can improve neurotransmitter and hormonal imbalances, as well as increasing neuroplasticity. These findings can be understood through mitochondria.
The direct effects of ECT on mitochondria have not been extensively studied. However, one group of researchers did demonstrate increases in mitochondrial activity of the hippocampus, striatum, and cortex of rats after delivering ECT.1 Another group found increased mitochondrial biogenesis and enhanced synapse formation in the hippocampus after just one ECT treatment.2 They also found that a series of ten treatments resulted in lasting improvements in the number of mitochondria and synapse formations three months later.
TMS has been shown to improve oxidative stress, reduce inflammation, increase neuroplasticity, and impact neurotransmitter levels.3 As you know, these all relate to mitochondrial function. The evidence for the direct effects of TMS on mitochondria, however, is also sparse. One study found an increase in ATP levels in a rat model of stroke.4 Another study found increased mitochondrial integrity after TMS treatment, also in a rat model of stroke.5
Interestingly, psychiatry isn’t the only field that uses electricity to fix metabolic problems. Cardiology commonly uses cardioversion (or shocking of the heart) when the heart is failing metabolically. Sometimes it just needs a jump-start.
Brain Surgery and Electrical Stimulators
Brain surgery is sometimes used as a last resort in people with chronic, debilitating mental disorders. Sometimes it can help. Why?
This is fairly straightforward. If an area of the brain is overactive due to hyperexcitable brain cells, cutting it off from the rest of the brain can decrease symptoms. This is commonly done in epilepsy treatment. The same applies to hyperexcitable brain regions causing mental symptoms.
In other cases, some brain surgeries implant electrodes to stimulate cells. This, too, is straightforward. It’s a way to stimulate underactive brain regions. It’s used in cardiology when pacemakers are implanted to deal with reduced function of the pacemaker cells of the heart. It works much the same way for underactive brain regions. Paradoxically, fast-paced stimulators can sometimes suppress overactive brain regions.
Electrical stimulators have also been applied to the vagus nerve. This is called vagal nerve stimulation, or VNS. This has been helpful for epilepsy and depression, and is also being studied for PTSD, Alzheimer’s disease, schizophrenia, OCD, panic disorder, bipolar disorder, and fibromyalgia.6 Again, one treatment for so many seemingly unrelated conditions. The brain energy theory connects them all.
Summing Up
For severe, treatment-resistant conditions or in life-threatening emergencies, ECT, TMS, VNS, and/or brain surgery can all play a role in treatment. However, the brain energy theory offers numerous other treatment options before these might be needed.