Depression is a phenomenon that has become a challenge to manage, even by experienced clinicians. The disconnect is recognizing and accurately diagnosing patients who are said to be suffering from depression. It is estimated that around 50% of individuals in the United States experience a major depressive episode yearly and are not diagnosed correctly. Of the other half that are identified and receive treatment, only half benefit from treatment and therapy. This is because they usually do not receive an adequate trial of therapy to achieve a reduction of symptoms sufficiently.
There is a critical need to improve depression identification in clinical practice and to create alternative therapies to manage depression better.
Is TMS Effective?
While the TMS device has been in the US market for ten years, researchers have continuously sought to improve its effectiveness. A typical TMS treatment is given 5 days/per week, and more studies are conducted to evaluate TMS and determine which is effective:
Length of treatment, frequency, intensity, and pattern of the pulses;
Maintenance schedule for patients who respond well to treatment.
Treating different areas of the frontal cortex;
Total treatments per day;
Total weeks of treatment; and
Patients suitable for treatment.
Three Cool TMS Research Studies
Stanford researchers have devised a treatment for depression that relieved symptoms in 90% of participants in a small study
A new form of magnetic brain stimulation rapidly relieved symptoms of severe depression in a small study conducted at Stanford University School of Medicine.
A team of researchers is conducting a larger, double-blinded trial to examine the effectiveness of electromagnetic stimulation in treating people whose condition hasn’t improved with medication, talk therapy, or other forms of electromagnetic stimulation. They hope that the second trial will be similarly effective.
Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) is a form of transcranial magnetic stimulation (TMS), which the Food and Drug Administration has approved for the treatment of depression. The researchers reported that SAINT increases efficacy upon current FDA-approved protocols by increasing the number of magnetic pulses, speeding up the pace of the treatment, and targeting each individual’s neurocircuitry.
Before undergoing therapy, all 21 study participants were severely depressed. Afterward, 19 of them scored within the non-depressed range and one participant scored within the mildly depressed range. Although all participants had suicidal thoughts before treatment, none reported having suicidal thoughts after treatment. All 21 participants had previously not experienced medication improvements, FDA-approved transcranial magnetic stimulation, or electroconvulsive therapy.
The only side effects of the new therapy were fatigue and some discomfort during treatment. The American Journal of Psychiatry published these results online on April 6.
Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences and a senior author of the study, said there has never been therapy for treatment-resistant depression that has broken 55% remission rates in open-label testing. The most common treatment for this condition is electroconvulsive therapy (ECT), which has an average 48% remission rate among patients with treatment-resistant depression. No one expected these kinds of results from ECT.
Major Contract Fuels Three-University Study of TMS for Treating Depression
Researchers from the University of California San Diego School of Medicine, Weill Cornell Medicine, and Stanford Medicine have launched a three-year collaborative study to investigate new ways to treat or prevent major depression. The project will also advance the application of effective treatments and develop predictive models to identify which treatments may work best for individual patients.
Major depression is an illness that affects over 21 million adults in the United States and 8 percent of all American adults. It is characterized by changes in mood and cognitive and physical symptoms.
The contract is part of a $50 million effort by Wellcome Leap, a non-profit founded by the Wellcome Trust and U.S.-based Foundation to accelerate breakthroughs for global health. The organization is built on a unique model of innovation practiced at DARPA, with the mission of funding novel, unconventional projects that target complex human health challenges.
The contract will support a program called “Multi-Channel Psych: Revealing Mechanisms of Anhedonia.” This program aims to shed light on the mechanism of anhedonia, which is common among people with depression and other mental health disorders.
“Depression is not a singular condition,” said Zafiris “Jeff” Daskalakis, MD, Ph.D., chair of the Department of Psychiatry at UC San Diego School of Medicine, who will co-lead the program with Conor Liston, MD, Ph.D., associate professor of psychiatry and neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine and Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences at Stanford Medicine. “It is an extraordinarily complex disease that, in many ways, is not yet well-understood. It is different for every person who suffers from it; each person needs their own personalized therapeutic strategy.”
The Effects of Functionally Guided, Connectivity-Based rTMS on Amygdala Activation and Depression
While repetitive transcranial magnetic stimulation (rTMS) is widely used to treat psychiatric disorders, improvements are needed. An important limitation is that while psychiatric disorders are associated with fronto-limbic dysregulation, rTMS does not have enough depth penetration to modulate affected subcortical structures.
“The objective of this pilot study was to test whether task-related, connectivity-based rTMS could modulate amygdala activation through its connectivity with the mPFC.”
The researchers found that the mPFC and amygdala were more active during active rTMS than a sham, which offers promising preliminary evidence for targeting functional connectivity with rTMS. Further research is needed to understand better how connectivity influences rTMS effects to leverage this information for improved treatments.
There are more TMS research studies out there to be read and discussed. If you are looking for reasons why transcranial magnetic stimulation is the next part of your journey, you can always visit us at 3939 Atlantic Ave., Suite 223, Long Beach, CA 90807, and contact us so that we can help you with the process.