Experimental treatment could significantly help 4 in 5 patients with severe depression

A new method of brain stimulation treatment from Stanford University has led to unprecedented remission rates in patients with moderate to severe depression.

“We just got used to something that works for 25% of people and we’re really excited about it,” Nolan R. Williams, MD, lead author of the study and director of the Stanford Brain Stimulation Lab told Verywell. .

But now Stanford Neuromodulation Therapy (SNT) appears to be working for a much higher percentage of people. This recent study shows that approximately 79% of patients went into remission within days of treatment. The remissions also lasted for months, and with few side effects.

Patients had previously not found much relief from depression with other standard treatments like antidepressants or psychotherapy.

SNT is essentially an updated form of transcranial magnetic stimulation, a therapy already used to treat depression. This new treatment, however, individualizes the stimulation to a patient’s neurobiology.

“I think the difference here is that we’ve tapped into that central biology of the disease,” Williams said. “This is the reason why we are seeing much higher numbers.”

The results were published in The American Journal of Psychiatry end of October.

How Stanford Neuromodulation Therapy Works

Brain stimulation therapy is not a new treatment.

Treatments like electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation are already approved by the Food and Drug Administration (FDA) and used to treat conditions like depression.

However, SNT is more similar to another FDA-approved therapy, repetitive transcranial magnetic stimulation (rTMS), a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. When patients receive rTMS, an electromagnetic coil is placed against the forehead, delivering painless magnetic pulses that stimulate regions of the brain that are believed to have underregulated activity in depression.

Since only a portion of patients (about a third) go into remission with rTMS, the Stanford researchers wanted to see if they could make the treatment more effective by individualizing it and increasing the intensity.

First, the researchers used brain imaging techniques to tailor treatment to each participant. Viewing the brain by MRI helped researchers locate the exact subregion in the dorsolateral prefrontal cortex that was most under-regulated with the subgenual cingulate. Both regions are thought to play a role in depression, and a deregulated connection between the two is linked to depressed mood and loss of pleasure.

At the same time, it is believed that rTMS strengthens the connection between the two domains. By individualizing the region that received the stimulation, the researchers hoped to make the treatment more effective for each participant.

In addition to tailoring the stimulation to each person, the researchers also tripled the number of pulses per session from 600 to 1,800. This high pulse has been used safely in the treatment of neurological disorders such as Parkinson’s disease.

Finally, the third change concerned the timing and frequency. Instead of the usual daily treatment, the researchers gave participants ten 10-minute treatments per day, with 50-minute breaks in between.

Nearly 80% experienced remission

Williams and his colleagues recruited 29 people with severe, treatment-resistant depression. They were treated in a controlled laboratory, all wearing noise-canceling headphones. Neither the researcher administering the procedure nor the participant knew whether they were undergoing an actual SNT or a placebo.

About half of the participants received SNT, while 15 received a placebo. The 29 participants were between 22 and 80 years old and had suffered from depression for an average of nine years. Not all individuals had received much relief through medication, psychotherapy, or other life changes, but those taking medication were instructed to maintain their regular dose.

Four weeks after treatment ended, researchers measured participants’ depression scores using the Montgomery-Åsberg Depression Rating Scale (MADRS). Twelve of 14 participants who received SNT improved, with 11 meeting FDA criteria for remission. In the placebo group, only two of 15 met the criteria for remission.

“We understand that you have to find the right place for everyone, and it’s different for everyone,” Williams said. Next comes correct pacing and dosing, which SNT updated by stepping up the pulse and treatment rate.

Although the remission rate was remarkable, the size of the study was still very small. Adapting the technique to a larger and more diverse patient population would be needed to tell how long and how long the effects of SNT last.

Another tool in the toolbox

About a third of patients with depression do not benefit from traditional treatments such as drugs and psychotherapy. This paved the way for the increasing use of brain stimulation therapies, which researchers like Williams and his colleagues seek to continue to improve.

“I think there is a lot more to do,” said Williams. That is, just because nearly 80% have gone into remission within one month of treatment doesn’t mean they will be in remission forever.

“So we have to find a way to keep everyone well, so it’s really 80% forever,” added Williams.

Extending the almost immediate effects of SNT could include its combination with other treatments, such as medications or lifestyle changes. “Some of these patients relapsed more quickly,” Williams said. “We have to find a way to keep them healthy. ”

There are already many tools available to treat depression, such as antidepressants, psychotherapy, and other brain stimulation treatments, but sometimes people don’t get the care they need. For example, over 75% of people in low- and middle-income countries do not receive any treatment. In places where treatment is more accessible, factors such as stigma could lead to misdiagnosis and / or prescription treatments that don’t work for the individual.

Antidepressants can also take a long time to work, causing treatment to drag on. Sometimes people spend months or even years looking for the best antidepressant for them.

But the rapid effects of SNT, still requiring further research, could speed up this treatment process and add another tool to the toolbox. If it proves safe and effective for people with treatment-resistant depression, it could, as the researchers said, be a game-changer.