Brain Mental health Sunnybrook Magazine Sunnybrook Magazine - Fall 2019

Sunnybrook is leading ground-breaking research for PTSD and alcoholism treatment

Serena Kelly

Serena Kelly with her husband Ron
(Photography by Kevin Van Paassen)

For years, Serena Kelly had been unsuccessful in managing her severe post-traumatic stress disorder (PTSD). A survivor of multiple sexual assaults through her teens, Serena found herself in a relationship marked by cruelty and abuse in her early 20s. Although she escaped her abuser at age 25, for nearly two decades afterward she and her family continued to be stalked and harassed by him, leaving her in constant fear for her life and the lives of her children.

The years of trauma took a toll. “I was unable to regulate my emotions and engaged in reckless and impulsive behaviours, self-harm, and made multiple attempts at suicide,” says Serena, 47.

After seeking help for her symptoms, Serena was diagnosed with PTSD in 2001. Over the years, she was prescribed mood stabilizers and numerous antidepressants. She also tried several forms of psychotherapy, but her symptoms remained.

Then came the call she will never forget. In Sept. 2017, Edmonton police called Serena and her husband at their Ontario home, informing them that their youngest daughter had been killed in a motorcycle collision.

“She had been the passenger on a sport bike and was ejected from the motorcycle after it struck another vehicle travelling in the same direction, killing her on impact,” she recalls.

Losing her daughter affected Serena profoundly.

“I couldn’t sleep, barely ate, was having horrible nightmares and intrusive images whenever I closed my eyes,” she says.

The sight and sound of motorcycles became an intense trigger that would cause Serena to go into a full-blown panic state, leaving her shaking, crying and hyperventilating. She didn’t want to drive anymore and was afraid to go anywhere alone for fear of being triggered.

“The world became very small and felt more unsafe than ever for me,” she says.

In 2018, Serena learned of a clinical trial at Sunnybrook that used deep-brain stimulation to treat PTSD. After meeting with the PTSD team at Sunnybrook, she joined the trial.

“I was relieved and finally felt a sense of hope for the future,” she says.

Click the photos above to learn more
(Photography by Kevin Van Paassen)

Deep-brain stimulation has been used in the medical community for years in severe cases of depression, anorexia nervosa, Parkinson’s disease and essential tremor. With this procedure, metal electrodes are surgically implanted in the brain. Doctors can then adjust the signals the electrodes produce, which is done via a battery pack that’s implanted in the patient’s chest, just under the collarbone.

The idea is to “disrupt the activity in the circuits of the brain” that are associated with addiction and reward, says Dr. Nir Lipsman.

When people have PTSD, for example, scientists hypothesize that “fear gets stuck [in the brain],” says Dr. Peter Giacobbe, study co-principal investigator, psychiatrist and clinical head at Sunnybrook’s Harquail Centre for Neuromodulation. So, when confronted with a stressor, a person with PTSD cannot stop the distressing panic and depression.

By influencing these circuits, the hope is the brain will begin to behave differently, and the patient will notice changes in their behaviour and mood.

Watch above: Serena talks about life after DBS

The team is also involved in a study looking at the use of deep-brain stimulation to treat people with treatment-resistant alcohol use disorder (AUD). People with AUD experience powerful cravings and cannot control how much alcohol they consume. Despite treatments like psychotherapy and medication, the rate of relapse is 75 per cent. The hope is that deep-brain stimulation will disrupt the brain activity that causes these cravings.

Dr. Lipsman says the idea of using deep-brain stimulation for hard-to-treat alcoholism and PTSD had been considered for a decade before Sunnybrook’s studies – both Canadian firsts. But it only came to fruition last year after a collaborative effort between different specialties within the Hurvitz program.

Patients enrolled in the PTSD study go through a comprehensive screening process and are assessed at regular intervals every few weeks. They also receive brain scans throughout the study. Dr. Giacobbe says the treatment can take a month or two to work, but symptom relief can be dramatic, to the point that some patients are no longer affected by their PTSD triggers.

“People can go back to work and re-establish their lives,” he says. “This is an exciting time in psychiatry.”

Each person may have a different response to deep brain stimulation due to a number of factors; age, severity of PTSD and medication. Some patients may not respond, while others notice a change after several months or even longer.

“We know that it can take time,” says Dr. Lipsman. “Change may be related to the circuitry or neurochemical changes that happen in the brain.”

Serena is encouraged by her success so far. After 10 weeks of having the electrodes implanted and adjusted to deliver gradually stronger signals to her brain, she no longer had violent reactions to motorcycles. She can now pass them while driving on the highway without any sense of panic, and she has experienced no side effects from the treatment.

“I go out more and am able to spend more time with my children and grandchildren, and enjoy those moments again, instead of being consumed by constant fear and anxiety,” she says.

Serena has been accepted to university and is currently pursuing a psychology degree. She says this is now possible because she is able to drive to school.

“I have my life and my freedom back.”

About the author

Anna Sharratt