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Finding hope in the treatment for depression

The Royal has new and innovative solutions

Two women and a man pose for a photo.
Jennie James (far right) with sister, Margaret (left) and father, Ben (centre).

Turning grief into hope

Melissa Kruyne and Jennie James grew up together in Ottawa. They met when they were six years old and stayed friends throughout elementary school, high school and university. Jennie’s incredible mind earned her scholarships to universities around the world. But that same mind kept letting her down. 

“Jennie could light up a room,” remembers Melissa. “But she was also a troubled soul.”

Early in their careers, life brought them both to Toronto and Melissa and Jennie moved into the same neighbourhood. Soon after, Jennie began to experience back problems. She underwent surgery and unfortunately continued to suffer from chronic pain, which impacted her ability to lead a normal life. Depression settled upon her and later went away, only to return again. 

Two young woman and an elderly man pose for a photo while sitting on a couch.

Alongside Jennie’s family and friends, Melissa tried to help her friend through the ups and downs. Melissa drove to Jennie’s many times in the middle of the night to support her friend as best as possible. On July 3, 2005, Jennie died by suicide. She was 33. An encouragement card posted the day she died, yet never received, still haunts Melissa.

“Not a week goes by without speaking of her,” says Jennie’s sister Margaret. “Her life and death continue to impact my family. Suicide is something that I hope fewer families and friends will need to face with the help of destigmatization, research and mental health programs.”

Depression profoundly impacts individuals and their friends and family, who often feel helpless. In 2006, Jennie’s father, Ben, started the Jennie James Depression Research Fund. The fund promotes awareness, understanding, research, and treatment of depression and seeks to end the silence surrounding suicide. 

Jennie’s death prompted Melissa to learn more about mental health, a cause she has grown to care deeply about.

“Jennie is why I got involved with The Royal. She was cared for by The Royal –- and her story is how I got started –- but it’s grown into so much more.”

Melissa’s family firm, Kott Inc., has since been a significant supporter of The Royal. It has led to some important conversations. The more people at the firm talked about mental health, the more people came forward with their own stories. Now led by Melissa’s brother, Ryan, mental health continues to be emphasized and supported in his dialogue with the employees. Members of Melissa’s own family have been through their own mental health challenges. Melissa says that despite her family’s vocal support over the years since Jennie’s death, mental health challenges remain difficult to discuss and address.

“It’s easier to be involved when it’s not about you. When it is you, then real life sets in. That’s where we have to be both brave and vulnerable.”

New hope for resistant depression

In 2021, The Royal successfully launched a pilot esketamine clinic – a non-invasive nasal spray form of ketamine that is used together with oral medication to help clients with treatment-resistant depression.

A portrait of a woman.

The service is modeled on best practices in integrating patient care, research, education, and collaboration. Interdisciplinary expertise offers innovative, measurement-based, evidence-informed care fully integrated with research.

The goal is to expand capacity and offer increased access to the clinic, develop additional research opportunities, and link the clinic to other available treatments and services at The Royal to maximize therapeutic outcomes and client satisfaction.

“Rapid-acting treatment strategies like esketamine offer clients access to specialized care,” says Dr. Jennifer Phillips, Scientist at the IMHR. “We hope to offer esketamine as part of a comprehensive treatment plan and give clients the opportunity to harness the rapid improvement in symptoms seen with esketamine to support their longer-term recovery from depression.”

Hope for people living with difficult-to-treat depression

After decades of fighting a debilitating depression, Sam was on the brink.

“I was just holding on. Literally talking myself out of taking my life every hour,” said Sam. “My depression was debilitating. I was going to die.”

Over the years,  Sam sat through hours of talk therapy and tried numerous medications, but nothing worked. 

Depression is the world’s leading cause of disability, with one-in-six Canadians diagnosed with depression at some point in their lifetime, and up to one third of them not responding to existing treatments.

Unfortunately, many also choose not to seek treatment because of the weight of stigma and discrimination. When left untreated, depression can lead to suicide.

Three years ago, Sam’s psychiatrist urged her to enroll in a study at The Royal designed for people with treatment-resistant depression. Every day for six weeks, Sam sat in a chair for five minutes while a magnetic field stimulated her brain.

At the end of the first day, Sam already felt a lift in her mood.

Bringing hope through research

The remedy was a new shorter form of repetitive transcranial magnetic stimulation (rTMS). Repetitive transcranial magnetic stimulation (rTMS), is a type of neuromodulation method that directly stimulates the specific brain circuits known to be dysfunctional in people with major depression. This is done by producing a brief, painless magnetic field delivered via a coil placed against the scalp. This approach is approved by Health Canada to treat depression in adults, and research expands this scope.

A woman holds a medical device to a patient's head

Dr. Sara Tremblay, a neuropsychologist and scientist at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal, Dr. Lisa McMurray and their teams, worked tirelessly for the past four years to bring an rTMS research clinic to The Royal. Her goal: to help those who have failed to respond to one or more different antidepressant medications.

 “Across the mental health landscape, clinicians, researchers, and clients are all becoming increasingly aware that there is an urgent need for new, alternative therapies for mental health disorders,” says Dr. Tremblay. “Neuromodulation offers us a whole new way of looking at mental health treatment, where we can identify malfunctioning circuits in the brain and effectively treat them in a non-drug, non-invasive way.” 

This dream of Dr. Tremblay’s became a reality in January 2020 when she began enrolling research participants in the study. The Royal’s Neuromodulation Research Clinic is the first of its kind in the Ottawa region and is quickly becoming a much sought-after, preferred treatment for depression as it has few side effects. 

Additionally, having rTMS as an alternative to drug interventions is useful for many people. Options are often quite limited when treating young adults with depression, and many elderly patients are also limited in using antidepressant drugs because of poor kidney or liver function. 

Those who live in large urban areas with private clinics can pay out of pocket for treatment, but for many, the only other way to access rTMS is through research.

Through this research clinic at The Royal, Dr. Tremblay is offering treatment to as many people as possible while collecting research data to help better predict and refine rTMS treatment.

“Research in this area is leading to a better, more personalized standard of care for patients with depression and related mental health disorders, for whom traditional treatments haven’t worked,” says Dr. Tremblay.