Spurt in brain stimulation offers cautious hope for depression

A significantly different approach to transcranial magnetic stimulation is promising, but needs further study.

Continuous line drawing of a depressed man sitting in a chair, head in hand, on a dark gray background

The basic tools we have for treating depression haven’t changed much in recent years. Medications and speech therapies are the mainstay. Lifestyle approaches, such as encouraging physical activity, adequate sleep and socializing, are often part of the package. If depression fails to lift, the next line of treatment for some may be a noninvasive form of brain stimulation called transcranial magnetic stimulation (TMS) which is helpful in certain cases and has very few side effects.

However, TMS requires a serious time commitment – usually a total of 36 sessions over six to nine weeks. Studies show that about a third of people who try it find it completely relieves their depression. A small, short-term study was recently conducted in American Journal of Psychiatry It has been suggested that a radical rethink of the way TMS is delivered may greatly enhance efficacy while shortening the treatment period to just five days.

What is transcranial magnetic stimulation?

Certain areas of the brain are known to be involved in depression and other mood disorders. TMS uses powerful electromagnets to safely activate these areas. A device placed on the upper forehead that gives short electromagnetic pulses. These pass through the skull to stimulate neurons in the target area. Over time, this technology leaves that part of the brain more active, which is then thought to affect entire brain networks responsible for regulating mood.

The most common side effect is temporary headache or discomfort at the site of stimulation. most dangerous and A rare possible side effect is seizure.

How effective is standard TMS for depression?

Despite progress since 2008, when the U.S. Food and Drug Administration (FDA) first cleared TMS for treating depression, not everyone has found TMS to be effective.

When considering treatment options, it is helpful to understand the difference between response and remission. Depressive symptoms are often measured using tools such as the Hamilton Depression Rating Scale. Response to treatment means symptom reduction of 50% or more; Remission means there are no specific symptoms on each scale.

The combined search appears on the standard TMS system About 30% of people go through complete remission of depression. This number varies somewhat across studies, devices, and treatment protocols. In particular, when antidepressants fail to relieve depression, this modest rate of remission is higher than would be expected if the person simply tried a different medication.

When TMS helps, depression begins to subside after a few weeks and continues to improve during the full course of treatment. These benefits last for about a year, in the middle. If depression returns, another course of TMS or a different treatment is often needed.

The Astonishing Promise of Saint . Protocol

Stanford researchers have modified standard TMS techniques to create a new protocol called Stanford Accelerated Intelligent Neurotherapy (SAINT, or SNT), which

  • An MRI is used to determine what is likely to be the optimal location in the brain for stimulation
  • Triple the number of beats per session
  • Increases the number of sessions to 50
  • The treatment is intensified in just five days by performing 10 sessions per day.

In one 1-month study, 29 people with treatment-resistant depression were randomly assigned to receive SAINT or a dummy version. At the end of the month, 78% in the SAINT group experienced complete remission compared to 7% in the sham group. It is noteworthy that this event Even better than electroconvulsive therapyThe current gold standard for treatment-resistant depression. SAINT therapy appears to be safe and well-tolerated, on a par with standard TMS.

Many unknowns in the new approach of TMS

Because of its potential, the U.S. Food and Drug Administration has granted permission to Magnus Medical, a biomedical company working with Stanford, to market SAINT through Path 510 (k) – Process based on safety trace history for TMS pre-certified devices. However, many questions must be answered before this new treatment is widely adopted.

  • Will the high cure rates hold across diverse treatment sites and diverse populations? Ideally, new treatment options are screened in larger, multicenter, randomized controlled trials before reaching the wider world.
  • How long do the positive effects last? A small, short-term study cannot show this, or suggest the best approach if depression recurs after a person completes express treatment.
  • Are the side effects different from standard TMS? While the adverse effects of standard TMS are well established and generally well tolerated, we don’t yet know if the same can be said for the SAINT protocol, given the small number of people who have tried it thus far.
  • What components in the SAINT protocol have the greatest impact on stroke remission rates? Can higher response rates be achieved with more accessible technologies? The SAINT protocol, as described, requires extensive expert planning using high-tech neuroimaging approaches that are not available in most parts of the country. Its implementation also requires dedicated equipment, personnel, and space that can disrupt other clinical operations. Perhaps modifications could be made that would maintain the benefit while improving the accessibility of a larger group of TMS providers and their patients.

Forging ahead with a new treatment: Buyer beware

Depression care is an area of ​​interest that is ongoing in this country. Developments such as the SAINT protocol have huge potential, but also many unknowns. With such excitement about the results of the new approach, it is no surprise that clinics are popping up across the country offering similar TMS services. But to what extent will these clinics strictly adhere to all elements of the SAINT protocol? We don’t have these answers, and we can’t be certain yet that following all of the items will lead to the same results in larger, long-term studies.

Currently, most sites that offer different types of this new treatment approach will not be covered by insurance. Rapid treatment will occur at a significant cost while still being limited by many unknowns discussed above. Before moving forward, people seeking treatment for depression and their clinical teams will have to determine the level of uncertainty they feel comfortable with.

SAINT technology has the potential to change the lives of millions of people with depression, but the latest study and subsequent approval from the US Food and Drug Administration (FDA) are only the first steps. Knowing exactly how this approach fits in is yet to come.

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