Reinventing depression treatment via transcranial magnetic brain stimulation (TMS)

Deirdre Lehman with Nolan Williams, who over­saw this clin­i­cal tri­al of a poten­tial treat­ment that uses tran­scra­nial mag­net­ic stim­u­la­tion. In the pho­to, Williams and Lehman demon­strate how a patient is posi­tioned and the equip­ment is used. Cred­it: Steve Fisch.

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Stan­ford researchers devise treat­ment that relieved depres­sion in 90% of par­tic­i­pants in small study (press release):

“A new form of mag­net­ic brain stim­u­la­tion rapid­ly relieved symp­toms of severe depres­sion in 90% of par­tic­i­pants in a small study con­duct­ed by researchers at the Stan­ford Uni­ver­si­ty School of Med­i­cine … In tran­scra­nial mag­net­ic stim­u­la­tion, elec­tric cur­rents from a mag­net­ic coil placed on the scalp excite a region of the brain impli­cat­ed in depres­sion. The treat­ment, as approved by the FDA, requires six weeks of once-dai­ly ses­sions. Only about half of patients who under­go this treat­ment improve, and only about a third expe­ri­ence remis­sion from depression.

Stan­ford researchers hypoth­e­sized that some mod­i­fi­ca­tions to tran­scra­nial mag­net­ic stim­u­la­tion could improve its effec­tive­ness. Stud­ies had sug­gest­ed that a stronger dose, of 1,800 puls­es per ses­sion instead of 600, would be more effec­tive. The researchers were cau­tious­ly opti­mistic of the safe­ty of the treat­ment, as that dose of stim­u­la­tion had been used with­out harm in oth­er forms of brain stim­u­la­tion for neu­ro­log­i­cal dis­or­ders, such as Parkinson’s disease.

Oth­er stud­ies sug­gest­ed that accel­er­at­ing the treat­ment would help relieve patients’ depres­sion more rapid­ly. With SAINT, study par­tic­i­pants under­went 10 ses­sions per day of 10-minute treat­ments, with 50-minute breaks in between.”

About the Study:

Stan­ford Accel­er­at­ed Intel­li­gent Neu­ro­mod­u­la­tion Ther­a­py for Treat­ment-Resis­tant Depres­sion (Amer­i­can Jour­nal of Psy­chi­a­try). From the abstract:

• Objec­tive: New anti­de­pres­sant treat­ments are need­ed that are effec­tive, rapid act­ing, safe, and tol­er­a­ble. Inter­mit­tent theta-burst stim­u­la­tion (iTBS) is a non­in­va­sive brain stim­u­la­tion treat­ment that has been approved by the U.S. Food and Drug Admin­is­tra­tion for treat­ment-resis­tant depres­sion. Recent method­olog­i­cal advances sug­gest that the cur­rent iTBS pro­to­col might be improved through 1) treat­ing patients with mul­ti­ple ses­sions per day at opti­mal­ly spaced inter­vals, 2) apply­ing a high­er over­all pulse dose of stim­u­la­tion, and 3) pre­ci­sion tar­get­ing of the left dor­so­lat­er­al pre­frontal cor­tex (DLPFC) to sub­gen­u­al ante­ri­or cin­gu­late cor­tex (sgACC) circuit…
• Results: One par­tic­i­pant with­drew, leav­ing a sam­ple size of 21. Nine­teen of 21 par­tic­i­pants (90.5%) met remis­sion cri­te­ria (defined as a score <11 on the Mont­gomery-Åsberg Depres­sion Rat­ing Scale). In the intent-to-treat analy­sis, 19 of 22 par­tic­i­pants (86.4%) met remis­sion cri­te­ria. Neu­ropsy­cho­log­i­cal test­ing demon­strat­ed no neg­a­tive cog­ni­tive side effects.
• Con­clu­sions: SAINT, an accel­er­at­ed, high-dose, iTBS pro­to­col with fcM­RI-guid­ed tar­get­ing, was well tol­er­at­ed and safe. Dou­ble-blind­ed sham-con­trolled tri­als are need­ed to con­firm the remis­sion rate observed in this ini­tial study.

The Study in Context:

• Machine-learn­ing study finds EEG brain sig­na­tures that pre­dict response to anti­de­pres­sant treatments
• Should Cog­ni­tive Behav­iour­al Ther­a­py (not anti­de­pres­sant drugs) be the first-line treat­ment for depression?
• Neu­ro­engi­neer­ing meets neu­roethics to address treat­ment-resis­tant depression
• CVS Health: Cog­ni­tive behav­ioral ther­a­py (CBT) apps may help you more than sleep­ing pills
• A call to action: We need the right incen­tives to guide eth­i­cal inno­va­tion in neu­rotech and healthcare
• New report: Empow­er­ing 8 Bil­lion Minds via Eth­i­cal Devel­op­ment and Adop­tion of Neurotechnologies
• 10 high­lights from the 2019 Sharp­Brains Vir­tu­al Summit