Two years ago, Dr. Eran Vadim Harel saw the film "Eternal Sunshine of the Spotless Mind." In this surrealistic romantic comedy, the hero, played by Jim Carrey, goes through a painful love affair and then seeks to erase the memories of his girlfriend from his mind. He goes to a psychiatric clinic that specializes in deleting memory selectively. "With the help of an instrument that is quite similar to our instrument," Dr. Harel relates, "the physician looks for the painful memories and neutralizes them. When I saw the film, it seemed like fantasy, science fiction, but suddenly I am not far from it in reality."

Harel, 35, a psychiatric resident, is currently conducting an intriguing study: treating depression through magnetic stimulation of the affected areas of the brain. The stimulation is carried out using a new, Israeli-developed technology that is unique in the world. Behind the development - and the registration of the patent in the United States - is another young researcher, Dr. Abraham Zangen, from the Department of Neurobiology at the Weizmann Institute of Science in Rehovot.

Research involving depressive patients is being conducted in the laboratory for the study of emotion and cognition at Shalvata Mental Health Center in Hod Hasharon, which is under the direction of Dr. Hilik Levkovitz. The new device is a transparent plastic helmet from which protrude electric coils that are attached to a computer. To the lay person, it looks like a machine from a 1960s science fiction movie combined with a hair dryer from an antiquated beauty parlor.

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Sitting beneath the helmet now is Gabriel Belachsan, a gifted musician who has long suffered from depression, for which he has been hospitalized and treated with medication. Belachsan lifts his arm in a gesture of greeting. During the treatment the patient is forbidden to speak. He is receiving stimulation of 20 hertz - 10 electrical pulses per second for two seconds, with a 20-second pause between each stimulation. This continues for 15 minutes.

Belachsan smiles and shows me the palms of his hands, through which a small tremor passes when the electrical stimulation is administered. "When I got here the first time," he says after the treatment, "I thought the instrument looked like some sort of monitor in a studio, something hallucinatory. I looked at it and thought to myself - this is going to be my salvation?"

The small reception room is full. Quiet, withdrawn people who have come from all over the country to take part in the research. One of them, Richard Hopkins, who has suffered from depression for 10 years, has come from England. Most of these people are suffering from forms of depression that are drug-resistant, so their last option is electric-shock therapy. But before taking that route, they have come to Dr. Harel's research study.

A decade ago, researchers claimed to have found a way to shock the brain and relieve depression by means of TMS - transcranial magnetic stimulation. This involves treatment in which a magnetic field is created in the brain by means of weak electric currents run through a coil placed on the patient's head. The magnetic field arouses nerve cells in the brain only in the region to which it is directed. The technology entered psychiatric use about 10 years ago, when it began to be used in research on victims of Parkinson's Disease. The patients very quickly reported an improvement in their frame of mind. Researchers then began to investigate the use of TMS technology for depression as well.

Depression is now defined as an illness of the brain. People with depression suffer from irregular electrical activity in various regions of the brain. Existing TMS instruments are limited in their ability to create a magnetic field capable of penetrating deep into the brain; instead, they succeed mainly in penetrating the outer sections of the brain, known as the cortex. The breakthrough came from Israel.

In 2003, in an article published in Scientific American, the American psychiatrist and neurologist Mark George likened the search for technology that would enable penetration of the brain to the medieval quest for the Holy Grail. George declared that the inventor of the neurological grail had been found: Dr. Abraham Zangen from the Weizmann Institute.

"What is new about this instrument is its ability to reach deep regions of the brain," Zangen explains. "If the previous technology made it possible only to reach the outer layer - a centimeter or two into the skull - the new instrument can penetrate to a depth of seven centimeters. That actually makes it possible for me to reach every place in the human brain without surgical intervention. Today, when we know that many pathologies, such as autism and depression, have their source in electrical activity within the brain, we can reach those places. We chose to focus on an experiment involving depression, because quite a bit of knowledge has accumulated concerning the specific locations of that pathology."

Why only now?
"The world is more than busy dealing with TMS technology. There is so much to study, even in the outer layer of the human brain, that researchers have more work than they can handle. Apparently no one thought of taking it one step further, another few centimeters into the brain."

According to Dr. Harel, the development of the new technology was inevitable, "but there are also great qualms, especially in connection with an instrument that can affect mental processes so simply."

Zangen developed the idea when he was studying "reward-related regions" in the human brain, a system involved in processes related to feelings of pleasure, which is damaged in people who are depressed or addicted. The original study was conducted on laboratory animals using an electrode implanted in the relevant nerve center of the brain. The next stage was to arouse the same stimulation without surgical intrusion. Thus Zangen was exposed to TMS technology.

At the start, a year and a half ago, 32 healthy students came to Shalvata and in return for a token payment agreed to be hooked up to the new TMS instrument that Zangen had developed. "A new instrument needs to be tried out on human beings," Harel explains, "and that is not a simple matter. We took 32 healthy people and gave them several parameters of stimulation and examined how this affected their immediate experience, its influence on cognition. That is done by means of simple half-hour tests on a computer."

Were there qualms about this experiment?
"Naturally there are qualms, as this is a new technology. Today it looks like something from science fiction. At that time it looked horrible, like a heap of junk that had been built in the backyard. But the students agreed and continued mainly because they were interested." The researchers focused the stimulation in the left prefrontal lobe ?(the prefrontal cortex?), a tangled circular nerve system in which electrical activity is known to be irregular in those suffering from depression.

"This is a place that is related to all high human functioning," Harel notes, "such as the ability to plan, the ability to assess a future situation, to imagine options, memory and language functions.

"I was the first to be tested," he says. "We examined several frequencies and found that a certain high frequency in the speech region, a state of 'high' was reached that began about half an hour after the stimulation and lasted two or three hours."

What did you feel?
"I was more focused, more concentrated, in a good mood, with a lot of energy. It is not an extreme feeling. It's a good feeling. It was very encouraging."

Softer landings
The results of the first study on the healthy students indicated an improvement in concentration, alertness, relaxation and even in the memory process. The next stage was to try the same technology on people suffering from depression. In the past two months, 26 such patients have undergone the experimental stimulation. They stopped taking antidepressant drugs and came to the lab every day for a month to receive the treatment.

Harel accompanies them on a daily basis in the form of conversations, support for family members and excitement at every tiny bit of progress. "The results are very surprising," he says. "The treatment is being given to people with major depression. There is an entire spectrum of types of depression. At the end of the spectrum is the depression that makes these people stop functioning and lie in bed all day. This is suffering and pain which people with depression describe as more than physical pain, and to put an end to it they are even ready to die. The longer the depression lasts, the farther away returning to some sort of functioning becomes. You slip farther and farther away, and sometimes it seems impossible to bridge the gap and return to normal life. A high percentage of those who suffered from the harsh form of depression will revert to it in the future.

"In terms of the ethics of research, when one introduces a new treatment, one goes to a population that did not succeed with a previous treatment. The people we are treating are suffering from depression that is not only serious, but also treatment-resistant. In other words, they are patients who did not respond to medicinal treatment or a population that suffered from side effects of antidepressant drugs. Such drugs have many side effects, such as weight gain and digestive tract disorders. The most perturbing side effect, though one that is not talked about much, is disorder in sexual functioning. The people here did not emerge from their depression for two, three or four years, and suddenly we see results."

Harel is cautious in his remarks, reluctant to develop unwarranted expectations and points out that the study is not yet over. At the same time, he says that every patient is a world unto himself and that it is hard for him to ignore a spark of reawakening, of a return to activity. He describes one case of a dramatic improvement that enabled a woman to return to work after four years in which she was incapable of working. However, in most vases the process is long, painful and slow.

Gabriel Belachsan, whom we had met earlier, is a founding member of Algir, a promising rock band active in Israel during the past decade. A few months ago the band released an album called "Sadot" (Fields), a singular album whose texts derive from the depths of Belachsan's psyche during his illness. "I suffer from manic depression and the depression is the dominant element of the illness," he says. "The disease has taken many years from me. I had an episode of a year and a half in which nothing helped. It's a depression that saps you of all your strength. You are like a walking pustule. My last episode with the depression was less violent, but I was like a zombie. Everything required a tremendous effort. Somehow I managed to maintain a semblance of routine - it turns out that there is routine even in hell. At one point I thought that this is it, it's my fate, it's me, and this is how I have to live. In order to feel something I had to fill myself up with alcohol, and afterward there's a terrible downer. There's no smile and no passion and no pleasure."

About six weeks ago, after collapsing, Belachsan checked himself into Abarbanel Mental Health Center in Bat Yam. The physician suggested the usual treatment for those who do not respond to drugs - electroconvulsive treatment. Belachsan, who had already undergone what he calls this "traumatic" treatment, declined.

(In electroconvulsive, or electric-shock treatment, two electrodes are attached to the temples and a current of electricity induces a spontaneous seizure. The treatment is carried out under general anesthesia. No one knows exactly what goes on in the human brain during the seizure, but it has been known for decades that a number of treatments will improve the condition of people suffering from deep or psychotic depression. "Electroconvulsive treatment can be likened to a blow to the head administered by a sledgehammer," Zangen explains, "compared with light and focused blows that occur in deep TMS." In addition, the electromagnetic treatment does not produce the side effects of electroconvulsive treatment, particularly the memory loss.)

Belachsan continues: "Then she told me about the study at Shalvata. I came for the interview with Dr. Harel without much hope. I remember the first treatments. It's as though it was a long time ago, but actually it was less than two weeks. At first it was a nightmare. I had no confidence. I came here heavy and exhausted. On the way from the entrance to the hospital and then to the laboratory I sat down on every bench along the way, like a 90-year-old. I was very skeptical that anything would help.

"I started the treatments," he continues. "There is no pain and no anesthetics. You enter and leave as though you weren't there. During the sixth treatment I began to feel that something was happening, something was waking up. It's hard to describe in words the awakening from depression. A certain relief. After the seventh treatment I went to see my parents at Moshav Talmei Yosef, and I remember the bus trip and I remember the Gabriel I know returning. Something returned to itself: the vitality, the colors, the senses. I got home and I saw my house as I hadn't seen it for months. I smelled the soil of the farm, the house, I heard music, and it touched me.

"After that, there was another deterioration. But that is typical of emergence from depression. Today, after 10 treatments, I feel better. I still have falls in the evening, but the landings are softer, less monstrous. It's a matter of days, what I feel now, and I would buy what I feel now for any price in the world."

Richard Hopkins, 35, a publisher from London: "For 10 years my illness has ranged from bad to worse. I saw the leading psychiatrists in England, I tried many drug treatments, but nothing worked. In the past year I left work and stayed home."

While surfing the Internet, Hopkins chanced on an article about the development of the new technology of Dr. Zangen and sent him an e-mail. Within a few minutes, the two were talking on the phone. Last week he received his 20th and last treatment, and according to Dr. Harel he has almost fully recovered. "It's an extraordinary treatment," Hopkins says. "You are aware of this thing on your head, you hear the knocking of the instrument. The change started after the first week. I was more relaxed and a bit happier. I was waiting for the next treatment. Today I feel more positive, with self-confidence and with energies. I am waiting to go home and continue my life from where I stopped it a year ago." In the meantime, Hopkins will remain in Israel for another month for follow-up observation.

Sciencefiction
Dr. Zangen has received calls from major research centers around the world and leading researchers in the field of neuropsychiatry have asked to take part in the studies. Zangen relates that a study on heavy smokers is now under way at Sheba Medical Center, Tel Hashomer. In the first stage, the smokers were given treatment by a TMS instrument of the previous generation. Now deep treatment is about to begin using the new device. In the near future, he says, another study on depressive patients will begin at Hadassah Medical Center in Ein Karem, Jerusalem. The patients there will be treated with frequencies different from those used at Shalvata.

"Our goal," Zangen says, "is to arrive at the optimal parameters in the treatment of depression. We still have many studies to conduct on the subject." "The field is in its infancy," Harel adds. "We are talking about 10 years of experimentation, which is nothing. We are at the bottom of the funnel, and it is going to develop in tremendous directions. It's science fiction."

In the meantime, the question that worries patients is what happens next. In more serious cases the illness recurs again and again. Every attack will be more intense and the return to normal functioning will be more difficult. Depression is liable to strike again even after successful medicinal treatment or electroconvulsive therapy; there is no immunity. Belachsan sums up the situation: "Depression can appear suddenly, in the middle of the schnitzel."

"What next? That is bothering all of us," Harel notes. "Some people feel good after the treatment and I would not recommend any additional treatment. Some have undergone several episodes of depression and for them I recommend taking a medication that might prevent the next bout of depression. I tell all the patients that I do not promise that the depression will not return. I don't pressure them - sometimes fear of depression can bring on depression.

"We are starting to monitor those who have completed the treatment. If the results turn out to be as we expect, we will expand the study to include more people. The goal is that one day this will be the regular treatment."