GO WITH THE FLOW… The new piece of tech that treats depression

Depression is one of the leading causes of disability worldwide, but could a new medication-free headset you wear at home really be a helping hand out of the darkness? Author Stephanie Merritt investigates…

I’ve always been enthusiastic about the idea of a fresh start. I love those seasons that seem like natural markers for a new chapter: new year, spring cleaning, back to school, significant birthdays. The start of a decade seemed especially momentous: a chance to reflect, know myself better, look forward to different prospects and leave behind the things that no longer served me.

But as the end of 2019 neared, I knew it wasn’t going to be as easy as that. It had been a tough couple of years, filled with the kind of difficulties that, individually, would have been manageable bumps in the road, but which, one after the other, had begun to wear down my resilience. The end of a relationship and the resulting need to move house; work contracts that didn’t come off through no fault of mine, but that left my professional confidence dented and finances tighter than usual; a minor operation and the subsequent wait for test results, which, though all ultimately fine, brought a period of stress and fear; the usual strains of being a single parent to a teenager.

Not one of these events was unfixable or life-shattering, so I gritted my teeth and kept going, trying to finish a new book, take on extra work and make sure I was around for my son when he needed me. There were moments when I felt overwhelmed, but they were rare; I thought I was strong enough to cope and, more importantly, I was buoyed by the fact that I was in love. I had found a new relationship with someone I had known for a long time, and through all these ups and downs, I was happier than I had been in years. At least, that’s what I told myself. And he did make me deliriously happy at first, so much so that when things began to go wrong, I convinced myself to gloss over it. I ignored warning signals because I wanted to go on believing he was everything I had hoped for and that it could still work. I wilfully went on hoping and denying reality for nearly six months, which is the emotional equivalent of trying to finish a marathon with a broken ankle. I realise I’m not the first woman to have done this, but I had imagined that, at 45, I had learned my lesson. Turns out I hadn’t.

It was as if finally acknowledging the end of something I had cared about so deeply allowed all the stresses of the

previous two years to catch up with me, and I crashed. I was not eating or sleeping. Everything made me cry. The only thing I looked forward to was seeing friends, but then I worried that I was terrible company, so would cancel plans at the last minute and stay home feeling sorry for myself. I couldn’t find any passion for my work, which is difficult as a novelist; staring at a blank screen all day only makes you beat yourself up more for your failings.

Fortunately, I’m familiar enough with depression by now to recognise when I need a bit of extra help. I’ve come to think of my depression as being like the Babadook in the film: you can’t get rid of it, but if you learn how to tame it and manage it, you can keep it mostly quiet and docile in the basement and go on with life. Learning how to tame it has involved, over the years, such basic self-care as regular exercise, enough sleep, vitamin supplements, diet, therapy, meditation and cutting out alcohol. But there are times, such as the end of last year, when it rears up so fiercely that it’s too strong for any of these daily measures.

I called my GP and made an appointment. I was planning to ask her, reluctantly, for antidepressants. It’s not that I’m against medication; at the lowest point of my postnatal depression, almost 18 years ago, those pills saved my life. But I found the side-effects difficult to deal

‘I COULDN’T PULL MYSELF OUT OF THE DARK PLACE ALONE’

with and since then I’ve tried every other way to stay off them. I knew that this time, though, I could not pull myself out of the dark place I was in without help, and I didn’t want to start a new decade weighed down by heartbreak. Even so, despite all I know about the value of intervention, I couldn’t silence that self-critical voice in my head whispering that going back on antidepressants meant I wasn’t strong enough to fight it on my own.

Then, while I was waiting for the appointment, I was offered the chance to try a new treatment for depression that had just been approved for medical use in Europe and the UK. Flow is a device that uses transcranial

direct current stimulation (TDCS) to activate neurons in the dorsolateral prefrontal cortex. If that sounds dauntingly complex, it’s the part of the brain that controls cognitive skills and emotional expression. People with depression can have lowered activity in this brain region, so the idea is that stimulation can help to rebalance it, making us better able to regulate our emotions. Controlled trials (published in The New England Journal Of Medicine and the British Journal Of Psychiatry) have indicated that TDCS can be as effective as antidepressants, but without the side-effects, and Flow is already being used in some private clinics alongside therapy, while its manufacturers are in talks with the NHS about making the device available on prescription.

It consists of a headset that sits high up on your forehead, with two electronic sensors just above your temples. The Flow headset connects to a phone app that controls the brain stimulation, but also tells you about other ways to combat depression through an interactive dialogue and animated videos. These might seem basic at first, maybe even a bit childish, with little primary-coloured stick figures showing how someone can get trapped in a spiral of depression, but when you’re feeling low, simple explanations are often all you feel able to cope with. The animations also offer a valuable reminder that depression is an illness, and that what you are feeling is not a failure or weakness on your part, which you can never hear often enough when you’re depressed.

I was nervous about trying the headset at first, since using electric current to treat mental health conditions has not exactly had a good rap over the years. ‘Ah, you’re doing your Cuckoo’s Nest thing,’ my son said when he saw me wearing the headset, referring to the deeply disturbing scene in One Flew Over The Cuckoo’s Nest, when Jack Nicholson’s character is held down and given electroconvulsive therapy (ECT) in the psychiatric hospital. Flow is not at all the same as ECT therapy, which is used rarely now and only under general anaesthetic. A very gentle procedure, the only discomfort with TDCS is a slight stinging on the skin where the current heats up.

The recommended course of treatment lasts for six weeks, with five half-hour sessions a week for the first fortnight, then two per week for the remainder of the course, with follow-up maintenance sessions as needed. It’s easy to fit it in when it suits you, and can be done sitting or lying where you won’t be disturbed (though not walking around – I tried this once and felt a bit dizzy). The only part that requires any effort is that you do need to be in the Flow app to make the headset work, so you can’t read a book or text a friend during the treatment. At first, this was frustrating, but it makes sense; to get the full benefit, you need to give the session your full attention.

I had checked with my GP before using Flow, though she had to remain neutral as it hasn’t yet been approved by the National Institute for Health and Care Excellence (NICE), but she didn’t see any reason not to give it a try.

The advice in the app, which offers sessions on the benefits of exercise, meditation and diet, was nothing I didn’t already know, though it was helpful to be reminded, and it would be a useful introduction for someone new to managing depression. You respond to Flow by means of pre-written messages, so that the dialogue looks like a text conversation, and often you have a choice of answers. The responses have been designed with a bit of humour: Flow has a cheery tone and will send you amusing animal gifs if you say you’ve completed a goal from the last session and, after a while, it did start to feel weirdly like a chat, even though you know it’s only a bot.

And then, to my surprise, about three weeks into the treatment, I felt something start to shift. I didn’t suddenly leap out of bed singing Walking On Sunshine, but it was as if a weight that had been crushing my chest had lifted. I began to feel as though I could raise my eyes and look at the road ahead without dread. This wasn’t an immediate response to a particular treatment session, it was gradual, but noticeable enough that I don’t believe it was just down to the passing of time. In my experience, that kind of depression doesn’t just lift of its own accord. It reminded me of the effect I felt when I first took antidepressants years ago, but without any of the unpleasant side-effects.

Often, the first step to breaking the spiral of despair is believing that things can improve. A helping hand, whether that’s from medication, therapy or a headset, can give you the motivation to engage with the activities that will help to keep you well in the long term, such as exercise, seeing friends and taking care of yourself. The difference I feel since starting the treatment is significant enough that I would recommend it to someone in the same situation (with the caveat that they should also seek advice from a doctor or therapist). I don’t know if Flow will turn out to be a magic bullet for everyone; I suspect that the cost (£399 for the headset) will mean the NHS waits for further clinical trials, but I did feel that it gave me a boost and allowed me to let go of a difficult year and step into a new decade looking forward to a fresh start.