Charlotte’s story

In many ways Charlotte’s life is unremarkable. Married, she lives in a large suburban home with her husband and children. She holds a management position with a large company, where she is in charge of client services. She’s proud of her high standing at work. Given her position, Charlotte is often asked to defuse sensitive situations. Clients say she’s outgoing and good with people.

Then Charlotte’s life begins to unravel. A marriage breakdown and subsequent divorce trigger a profound change. Seemingly overnight Charlotte withdraws. She becomes severely depressed and incapable of work. She is plagued by constant fatigue, can’t sleep and can’t imagine the future. Her children no longer give her any joy. Nothing does. She even begins to entertain thoughts of suicide.

Her profound depression lasts two years. During this time, Charlotte’s doctor tries a number of therapies, including drugs and psychiatric counselling, but nothing works. Frustrated by the lack of success, her doctor refers her to the Douglas Depressive Disorders Program.

Charlotte at the Douglas

When Charlotte arrives for evaluation at the Douglas, Gustavo Turecki, MD, PhD, who leads the Depressive Disorders Program, cannot connect the professional described in the notes with the woman sitting in his office. He sees a person who is lethargic and timid. Completely unresponsive, she cannot even lift her eyes from the floor.

Charlotte is accepted for treatment. But at first even the Douglas’s superspecialized clinic makes little headway. At a certain point, however, they try transcranial magnetic stimulation (TMS), which works on some patients by stimulating parts of the brain associated with depression. With Charlotte, TMS is the trigger they’ve been looking for. There is an immediate and marked improvement, which the entire team — including the social worker, psychotherapists and others — begins to build on. Following the first TMS therapy, Charlotte’s treatment lasts less than a year.

As part of the recovery process, the team arranges for Charlotte to ease back into work part-time. On her first day back, the entire office stands and gives Charlotte an ovation. After four months back at work, Charlotte receives a promotion.

Turecki recalls Charlotte when she first walked into his office. “She’s a completely different person,” he says. “Unrecognizable.”

Dr. Turecki and his Team

Gustavo Turecki, MD, PhD, heads The Douglas Depressive Disorders Program for children and adults (the children’s section is led by Johanne Renaud, MD, FRCPC). With a caseload of about 200 patients, the superspecialized (third-line) program offers cutting-edge treatments, available nowhere else in Québec, for severely depressed patients who respond poorly to conventional therapy. These cases have languished in the “system” for years and have developed associated issues, including personality problems. “Our is the only program on depression in Québec that truly integrates clinical practice and research.”

The economic consequences of depression are familiar to the business world, and Turecki admits that many patients referred to his program are former professionals and senior executives.

Among the clinic’s therapies is the use of transcranial magnetic stimulation (TMS), which is highly effective on some patients. Clinicians use TMS, in conjunction with medication, to stimulate specific areas of the brain and nerves that have been found to correlate with improvement.

Turecki also leads the McGill Group for Suicide Studies, based at the Douglas, which studies risk factors for suicide, including depression. Québec has among the highest rates of suicide in Canada (excluding the territories).