Wednesday, May 5, 2021

TMS, Autism, and Depression

In an interview at The Cut, John Elder Robinson claims that transcranial magnetic stimulation, or TMS, caused him to "wake up" from autism; among other things he was suddenly able to feel, viscerally, the power of angry insults, and the beauty of a pair of eyes. 

I left the hospital figuring nothing had happened: I was thinking to myself, What kind of crazy fool was I to think that I was gonna do this TMS and suddenly the world was gonna change? But then I got in the car to go home, and I turned on my iPod and it just hit me that the music was real and alive. It had a power and clarity I hadn’t experienced before, and I started thinking about who the song was written for and what it was about. . . . The next day at work I looked at one of my colleagues and I thought to myself: He has the most beautiful brown eyes. That’s the type of thought I simply do not have. I don’t usually have any comment on your eyes because I don’t look in anyone’s eyes. For me to look in your eyes and say that they are beautiful is totally out of character. When I got to work I walked into the waiting room, as I usually do, and I looked at everyone and there was this flood of emotion. I could see it all: They were scared and anxious and eager, and never in my life had I seen something like that. I had to step out of the room because I didn’t know how to cope. It felt like ESP.

The interview is impressive enough that I spent some time reading about TMS. Here's a quick description:

TMS is a noninvasive procedure that uses magnetic pulses to stimulate nerve cells in the brain. During treatment, a coil is placed against the patient’s scalp and the TMS energy passes through the skull into the outermost layer of the brain. While the idea of electrical brain stimulation has been around for centuries, early techniques involved inserting actual wires — a dangerous and risky procedure. Noninvasive stimulation via electromagnetic energy is much newer — the first successful experimental use took place in the ‘80s. Since then, it’s evolved into a powerful tool for neuroscientists. It’s also a therapeutic tool for stroke recovery, depression, and anxiety relief.

Various claims have been made over the past few years that it can "cure" autism. Better studies, alas, have not confirmed this. What is really driving interest in the therapy is not a desire to eliminate autism, but to treat depression in autistic patients. I did not know until yesterday that high-functioning autistic people suffer much more depression than others, with some studies finding rates as high as 50%. SSRIs don't seem to work very well, because they mainly to make autistic people irritable.

Here's a summary of a recent major study:

In a pilot study in adults with autism and depression, transcranial magnetic stimulation, or TMS, was effective in reducing depressive symptoms and had some effects on autistic symptoms, report researchers at the Medical University of South Carolina in Autism Research. This study suggests that TMS warrants further study as a potential treatment for adults with both depression and autism.

This has me wondering about how autism and depression might be connected; both seem to flatten the emotional world. Since the medical literature I can find isn't very encouraging about TMS as a "cure" for autism, could it be that what really happened to Robinson was a lifting of depression? On the other hand his description of being suddenly overwhelmed by other people's emotions doesn't fit that very well.

Fascinating, whatever is really going on.


G. Verloren said...

I would urge caution in talking about autism as being a flattening of emotionality - that's true of some kinds of autism, but totally backwards for other kinds.

Many autistic people in fact have heightened emotionality, or otherwise "normal" emotionality that simply is understood and communicated through different means.

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