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'An incredible window into the brain': New treatments target severe depression

At 35, Sharon Jakab knew something was wrong when she started hallucinating.

"I saw my grandmother on the wall in the room. She was talking to me. I wasn't sleeping, and I was a mess," she says from her home in Burlington, Ont.

About a year and a half later, Jakab was suffering from postpartum depression following the birth of her second child. It became so bad, she was suicidal. "There was a gun in the house and there were cartridges. I was all set to kill myself."  

She had to suicide-proof her home by taking away all dangerous objects, even skates, which have sharp blades.

Sharon Jakab, right, received magnetic seizure therapy this year to deal with her severe depression. She and her partner Karen Inkster suicide-proofed their home in Burlington. Ont. (Craig Chivers/CBC)

Now 61, Jakab has been in and out of hospitals, dealing with what she calls "waves of depression" that have lasted most of her adult life. She's tried about a dozen medications, including the antipsychotic drug clozapine.  "Clozapine really helped me a lot, but I still suffered from depression, psychosis and mania."

Because standard treatment like medication and therapy weren't effective, Jakab was diagnosed with treatment-resistant depression, a severe form of depression that close to a million Canadians experience.

'A huge public health problem'

Electroconvulsive therapy or ECT, better known as shock treatment, is still considered the go-to treatment but comes with the common side effect of memory loss. So doctors are now exploring less invasive experimental approaches like brain stimulation that rewires the brain's circuits. 

"Hard-to-treat depression is a huge public health problem" says Dr. Jeff Daskalakis of Toronto, at the Centre for Addiction and Mental Health's Temerty Centre for therapeutic brain intervention. "The idea that treatments that could potentially rectify or improve their illness can be very reassuring to patients."

Dr. Jeff Daskalakis is working on new ways to deal with treatment-resistant depression. One method uses magnets instead of electricity to induce a seizure in a patient. (Craig Chivers/CBC)

One of those treatments being tested at CAMH is magnetic seizure therapy or MST. A magnetic coil to the front part of the patient's head delivers a high-frequency pulse that induces a seizure. A big advantage is there are few or no adverse effects like memory loss.

"If we can limit those effects by delivering the stimulus at a much lower intensity with an alternative type of approach, in this case magnets as opposed to electricity, we can spare cognition and produce a seizure that gets people better," says Daskalakis.

Over 150 patients have received MST during clinical trials at CAMH.

Jakab  jumped at the chance of getting the treatment. "I didn't want to have ECT", she says. "I had One Flew Over the Cuckoo's Nest image in my mind," she adds, referring to the movie where Jack Nicholson gets a jolt of electricity through his head.

Over eight months last year, Jakab received 30 sessions of MST. "I felt what I call lighter, because I feel less sad, less depressed, and the suicidal thoughts diminished."

Dr. Daniel Blumberger is part of a research team at the Centre for Addiction and Mental Health in Toronto looking at non-invasive therapies for treatment-resistant depression. (Craig Chivers/CBC)

"I think what's challenging about treating depression is that everybody is different, and people come to it in a different way", says Dr. Daniel Blumberger, medical head of the Temerty Centre. "There are probably multiple different types of depression, and finding the right treatment for the right individual is probably the next phase of delivering treatment for the illness."

Blumberger has been working on a less invasive technique than MST, called repetitive transcranial magnetic stimulation, or rTMS. It delivers a repetitive burst of magnetic pulses to the part of the brain affected by depression.

Over 1,000 patients have used the treatment which lasts three minutes. A study published in The Lancet this year showed how effective the treatment is, compared to the standard length of about 37 minutes.

"The outcome can be dramatic", says Blumberger. "We will see a clinically significant response in about 50 per cent of patients, and 30 per cent of people have remission of their depressive symptoms."

'Ninety per cent of what we've learned about the brain, we've learned in the last 10 to 15 years,' says Toronto psychiatrist Dr. Anthony Levitt. (Craig Chivers/CBC News)

At Sunnybrook Health Sciences Centre in Toronto, researchers have been using a technique called MRI-guided focused ultrasound to help patients overcome hard-to-treat depression. With pinpoint accuracy, ultrasound beams heat and disrupt specific areas of the brain associated with depression.  

"The ultrasound goes directly to that circuit, makes a cut, and stops it from firing when it shouldn't be firing," says Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program at the hospital. "This is an incredible window into the brain. We no longer have to open the skull to cause damage to the brain."

He adds, "Ninety per cent of what we've learned about the brain, we've learned in the last 10 to 15 years."

Sky Zazlov of Toronto was one of the first patients to try the ultrasound treatment in May. She was diagnosed with treatment-resistant depression in 2011.

"It seems unrelenting," she says. "I don't even know how to explain it because it's not angering, it's frustrating."

Sky Zazlov, right, with her son Isaak, was diagnosed with treatment-resistant depression in 2011. Close to one million Canadians suffer from this condition. (Craig Chivers/CBC)

Before she was placed inside the MRI scanner, technicians shaved her head and fitted her with a round metallic helmet that transmits the ultrasound waves. The procedure lasts several hours, and as the patient is wheeled out, it's too soon to know if the treatment worked.

A few months later, Zazlov is disappointed. There have been no changes in her mood. But she says she's not giving up. Neither are her doctors, who've told her it could be up to a year before the treatment provides some relief.

"I'm not looking for a magic bullet," says the 40-year-old mother. "I'm willing to put the work in, but I hope this will take away some of the despair."

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'An absolute monster': Florida reckons with Michael's devastation as it hits Carolinas

The devastation inflicted by Hurricane Michael came into focus Thursday with rows upon rows of homes found smashed to pieces.

Search crews began making their way into the stricken areas in hopes of accounting for hundreds of people who may have defied evacuation orders.

At least seven people were killed by the hurricane — the most powerful to hit the continental U.S. in over 50 years — in Florida, Georgia and North Carolina, according to state officials. They included a man who was killed after a tree fell on a Florida home and an 11-year-old girl who died when a portable carport crashed through a roof in Georgia.

Though weakened into a tropical storm, Michael continued to bring heavy rain and blustery winds to the Southeast as it pushed inland. The storm was expected to move across North Carolina and Virginia and push into the Atlantic Ocean by late Thursday or early Friday.

Hector Benthall, right, gets a hug from his neighbor Keito Jordan after remnants of Hurricane Michael sent a tree crashing into Benthall's home on Thursday in Columbia, S.C. Jordan was the first responder to the accident that sent at least one person to the hospital. (Sean Rayford/Getty Images)

Over 900,000 homes and businesses were without power in Florida, Alabama and Georgia Thursday, with search-and-rescue efforts underway in those states. The Army Corps of Engineers was supplying generators to help get power to storm-ravaged areas and teams to start clearing debris and begin building temporary roofs.

"This morning, Florida's Gulf Coast and Panhandle and the Big Bend are waking up to unimaginable destruction," Florida Gov. Rick Scott said.

"So many lives have been changed forever. So many families have lost everything. … This hurricane was an absolute monster."

In Florida, the town of Mexico Beach appeared to be "ground zero," said Brock Long, director of the Federal Emergency Management Agency.

A reporter and photojournalist from the Tampa Bay Times ventured there in the dark early Thursday, finding the town of about 1,000 almost impassable. They reported seeing many destroyed homes, some with staircases leading to doors suspended three metres in the air with nothing on the other side, entire structures washed away. Refrigerators and toilets and piles of soggy furniture were strewn across properties.

Watch aerial footage of damage caused in Florida from Hurricane Michael's direct hit. 1:20

In Panama City, downed power lines lay nearly everywhere. Roofs were peeled away and sent airborne. Aluminum siding was shredded to ribbons. Homes were split open by fallen trees, hundreds of cars had broken windows and twisted street signs lay on the ground. 

The National Hurricane Center said the storm was centred about 40 kilometres south of Greensboro, N.C., as of 2 p.m. ET., moving northeast at 37 kilometres per hour. Top sustained winds were 85 km/h; the storm made landfall in Florida on Wednesday afternoon with top sustained winds of nearly 250 km/h.

Forecasters said it could drop up to 18 centimetres of rain over the Carolinas and Virginia before pushing out to sea.

Officials hoped the fast-moving nature would limit the impact of flooding in the Carolinas, where rivers in several counties rose dangerously as a result of Hurricane Florence last month.

"For North Carolina, Michael isn't as bad as Florence, but it adds unwelcome insult to injury, so we must be on alert," Gov. Roy Cooper said.

Floridians survey damage in the coastal township of Mexico Beach, which lay devastated on Thursday after Hurricane Michael made landfall on Wednesday in the Florida Panhandle. (Douglas R. Clifford/Tampa Bay Times via AP)

The U.S. Coast Guard in Mobile, Ala., said its crews had rescued 27 people, mostly from damaged homes, while in Panama City, Fla., a Jayhawk rescue helicopter crew pulled nine people from a bathroom of a home after a roof collapsed Wednesday afternoon.

The coast guard said there were no reports of deaths from their missions across the Florida Panhandle.

'Do you think it would have floated away?'

A National Guard team got into Mexico Beach and found 20 survivors overnight, and more crews were pushing into the area in the morning, with the fate of many residents unknown, authorities said. State officials said 285 people in Mexico Beach had refused to leave ahead of the hurricane despite a mandatory evacuation order.

Mishelle McPherson and her ex-husband searched for the elderly mother of a friend. The woman lived in a small cinderblock house about 137 metres from the Gulf and thought she would be OK.

Her home was reduced to crumbled cinderblocks and pieces of floor tile.

"Aggy! Aggy!" McPherson yelled. The only sound that came back was the echo from the half-demolished building and the pounding of the surf.

"Do you think her body would be here? Do you think it would have floated away?" she asked.

As she walked down the street, McPherson pointed out pieces of what had been the woman's house: "That's the blade from her ceiling fan. That's her floor tile."

Mishelle McPherson looked Thursday for an elderly acquaintance she believes did not follow evacuation recommendations, in Mexico Beach, Fla. (Gerald Herbert/Associated Press)

Storm-related road closures included a 125-kilometre stretch of Interstate 10 in Florida as a result of what an official called "extremely hazardous conditions," as well as the Talmadge Bridge on U.S. 17 between Savannah, Ga., and South Carolina, which was closed because of the threat of high winds on the suspension bridge that spans the Savannah River.

Michael sprang quickly from a weekend tropical depression, gaining strength from the warm Gulf of Mexico waters to a Category 4 hurricane. It moved so fast that people didn't have much time to prepare, and emergency authorities lamented that many ignored the warnings and seemed to think they could ride it out.

Amanda Logsdon begins the process of trying to clean up her home Thursday in Panama City after the roof was blown off by the passing winds of the hurricane. (Joe Readle/Getty Images)

The Red Cross said 7,800 evacuees took refuge in 100 shelters across three states. It has prepared cots and supplies across the affected states for a greater number of people, given the expectation many homes will be uninhabitable for some time.

Based on its internal barometric pressure, Michael was the third most powerful hurricane to hit the U.S. mainland, behind the unnamed Labour Day storm of 1935 and Camille in 1969. Based on wind speed, it was the fourth strongest, behind the Labour Day storm, Camille and Andrew in 1992.

With files from Reuters and CBC News

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'An unspoken injury of war:' U.S. surgeons perform extensive penis transplant

A U.S. veteran who lost his genitals from a blast in Afghanistan has received the world’s most extensive penis transplant, and doctors say he is recovering well and expected to leave the hospital this week.

Saying they wanted to address “an unspoken injury of war,” Johns Hopkins University surgeons rebuilt the man’s entire pelvic region — transplanting a penis, scrotum and part of the abdominal wall from a deceased donor — in a highly experimental 14-hour operation last month.

Such transplants “can help those warriors with missing genitalia just as hand and arm transplant transformed the lives of amputees,” Dr. W.P. Andrew Lee, Hopkins’ chairman of plastic and reconstructive surgery, told reporters Monday.

The patient, who asked to remain anonymous, is expected to recover urinary and, eventually, sexual function.

Penis transplants have generated intense interest among veterans from Iraq and Afghanistan.(Devon Stuart for Johns Hopkins Medicine)

The scrotum transplant did not include the donor’s testicles, meaning reproduction won’t be possible. “We just felt there were too many unanswered ethical questions” with that extra step, said Hopkins’ Dr. Damon Cooney.

Three other successful penis transplants have been reported, two in South Africa and one in 2016 at Massachusetts General Hospital.

Those transplants involved only the penis, not extensive surrounding tissue that made this transplant much more complex.

The loss of a penis, whether from cancer, accident or war injury, is emotionally traumatic, affecting urination, sexual intimacy and the ability to conceive a child. Many patients suffer in silence because of the stigma their injuries sometimes carry.

Doctors sometimes reconstruct the form of a penis from a patient’s own skin, usually to treat congenital abnormalities or during transgender surgery. That requires using implants to achieve erection.

For a functional penis transplant, surgeons must connect tiny nerves and blood vessels. Candidates face some serious risks, including rejection of the tissue and side effects from anti-rejection drugs that must be taken for life.

But penis transplants have generated intense interest among veterans from Iraq and Afghanistan, and a few years ago Hopkins surgeons began planning and rehearsing how to perform such a complex operation in patients with widespread tissue damage.

‘I felt finally more normal’

The Department of Defence Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013. It’s not clear how many victims lost all or part of the penis.

Hopkins is screening additional veterans to see if they are good candidates for this type of reconstructive transplant. Finding donors is an additional hurdle: In the U.S., people or their families who agree to donate organs such as the heart or lung must be asked separately about also donating a penis, hand, face or other body part.

The Hopkins patient received an extra experimental step, an infusion of bone marrow from his donor that research suggests may help a recipient’s immune system better tolerate a transplant.

Surgeons said that is enabling the veteran to take one anti-rejection drug instead of several.

In a statement from Hopkins, the patient was quoted as saying: “When I first woke up, I felt finally more normal.”

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Shirtless Donald Trump Showers With Paul Manafort, Calls Harvey Weinstein 'an Idiot' in 'SNL' Cold Open

“We’re in the shower to make sure you’re not wearing a wire, Paul,” a shirtless Trump explained. “So we’re just gonna do this Gone Girl style.”

“Mr. President, I would never do that,” a shirtless, uncomfortable Manafort replied.

“That’s what she said. In fact a whole bunch of shes have said that,” Trump replied, mocking his own highly publicized history of alleged sexual harassment and misconduct scandals.

“Speaking of which, what an idiot that Harvey Weinstein is,” Trump continued. “He could have gotten away with all of it, if only he’d gotten himself elected president.”

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'An emotional moment' as first same-sex couples set to wed in Germany

Almost 40 years after their first kiss, Karl and Bodo are getting hitched.

The two civil servants from Berlin are expected to become the first gay couple to tie the knot in Germany when a law allowing same-sex marriages takes effect Sunday.

Until now, gay and lesbian couples in Germany only were able to enter into registered partnerships that gave them fewer legal rights than married heterosexual couples.

“This is an emotional moment with great symbolism,” Karl Kreile said as his wedding day approached. “The transition to the term ‘marriage’ shows that the German state recognizes us as real equals.”

Kriele, 59, and his partner, Bodo Mende, 60, have been at the forefront of campaigning for gay rights in Germany since meeting in 1979 in what was then West Berlin. The city at that time was a magnet for people seeking to escape the political and social constraints on both sides of a divided Germany.

‘The transition to the term “marriage” shows that the German state recognizes us as real equals’– Karl Kreile, civil servant

Kreile recalled the “shame” he felt in 1992, amid a new spirit of optimism three years after the fall of the Berlin Wall, when he and Mende marched into a registry office and asked to be married, only to be politely turned away.

The couple registered their partnership 10 years later, after Germany became one of the first countries worldwide to allow civil unions. But as other countries began legalizing same-sex marriages, Germany fell behind, in part due to Chancellor Angela Merkel’s opposition.

23rd country to allow same-sex marriage

Merkel, who has been chancellor for 12 years, agreed to let parliament hold a free vote on same-sex marriages in June, three months before a national election.

She voted against the move herself, but a majority of lawmakers backed the measure, making Germany the 14th country in Europe and the 23rd worldwide to allow same-sex couples to marry.

Mende thinks the result might have been different if the vote were held now, given the rightward shift in German politics after the Sept. 24 election.

The upstart Alternative for Germany party, which won seats in parliament for the first time, campaigned mainly against immigration and Islam. But its platform also opposes full equality for same-sex couples even though one of its leaders, Alice Weidel, is openly lesbian.

“I regard them as political enemies,” Kreile said.

He cited recent crackdowns on lesbians and gay men in Poland, Russia and Turkey as evidence that LGBT rights can’t be taken for granted anywhere.

Joerg Steinert, who heads the Berlin branch of Germany’s lesbian and gay association, LSVD, said being able to marry will have tangible benefits for same-sex couples, including the right to adopt children. The first such adoption is expected to take place in Berlin on Oct. 4, he said.

Germany Gay Marriage

Men with rainbow flags stand in front of the Brandenburg Gate at an event organized by the SPD to celebrate the legalization of same-sex marriage in Berlin. (Michael Kappeler/Associated Press)

Steinert said the change also will take a load off Germany’s famously complex bureaucracy, by removing hundreds of special exceptions — in areas ranging from university loans to hunting regulations — that were put in place over the years as same-sex couples successfully challenged discrimination in the courts.

Some hurdles remain

The computer system used to record marriages in Germany currently requires one partner to be registered as the man, the other as the woman. Kreile and Mende haven’t made up their minds who will be which, and officials say the fields can’t be changed even after the system is upgraded next year.

Such problems won’t spoil the party on Sunday, said Steinert, “but it’s embarrassing for the German government.”

Some local authorities in Germany have enthusiastically embraced the prospect of same-sex marriages, even deciding to open their registry offices on a Sunday to conduct and celebrate the first gay and lesbian weddings.

Among them are the northern city of Hamburg and the Berlin district of Schoeneberg, which has been the centre of gay life in the German capital for more than a century.

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