A 5-day treatment to stimulate the brain is highly effective against depression, researchers from Stanford have discovered

Magnetic resonance imaging machine.  MRI scanning is used to adjust the patient's brain stimulation.

Magnetic resonance imaging machine. MRI scanning is used to adjust the patient’s brain stimulation.
Photography: Alain Jocard / AFP (Getty Images)

Researchers from Stanford think that they have devised an efficient and fast way to treat severe cases of depression, improving the already approved form of brain stimulation. In a new study released this week, researchers found that nearly 80% of patients improved after treatment – a far higher rate than those given a fake placebo.

There is brain stimulation he showed up as a promising pathway for depression, especially depression that did not respond to other treatments. The basic concept behind this is the use of electrical impulses to balance erratic brain activity associated with neurological or psychiatric disorders. There are different forms of stimulation, which differ in intensity and the way they work with the body. Some require permanent implants in the brain, while others can be used noninvasively, such as repetitive transcranial magnetic stimulation (rTMS). As the name suggests, rTMS relies on magnetic fields that are temporarily applied to the head.

rTMS has been approved since 2008 by the Food and Drug Administration for patients who do not respond to at least one other treatment. But the success rate is modest, with about 14% to 30% of patients experience significant remission. And while it is safe and requires less maintenance than other forms of stimulation, a typical single course lasts about six weeks, which is less than ideal for patients experiencing an emergency depressive episode.

In recent years, scientists from Stanford University School of Medicine have been trying to improve rTMS. Their technique, now called Stanford neuromodulation therapy (SNT), relies on higher doses of magnetic impulses delivered through a faster, five-day schedule, which should mimic about seven months of standard rTMS treatment. The treatment is also personalized for each patient, using MR scans beforehand to select the best possible locations along the brain to deliver these impulses.

“We were very interested in trying to solve psychiatric problems in emergency conditions, where we treat people during the day. And so we came up with a way, based on the principles of human neuroscience, to compress stimulation from a six-week schedule into one day, ”study author Nolan Williams, an assistant professor of psychiatry and behavioral sciences at Stanford, told Gizmodo. phone.

Last year, Williams and his team released a small study of the 21 patients who received SNT, showing that 90% of people severely affected by depression experienced remission – in other words, that they no longer met the criteria for an acute depressive episode. Moreover, people’s feelings about suicidal ideas have disappeared. The study, however, was open, meaning patients and doctors knew what treatment was being given. Confirmation that any drug or treatment actually works requires more rigorous tests, such as a double-blind and placebo-controlled experiment. And that’s what the team has now done, publishing the results of its new study in the American Journal of Psychiatry.

Obviously, finding a placebo for brain stimulation is not as easy as asking people to take a sugar pill in a standard drug trial. Instead, patients will go through a sham stimulation session, where the procedure is performed to the point where patients think they are stimulated, but only a weak or no pulse is actually used. In this new study, 29 participants with treatment-resistant depression were randomized to obtain true SNT or false. They were followed for four weeks after that.

This time, about 78% of patients given the original SNT experienced remission, based on standard diagnostic tests, compared with about 13% of the false group. There were no serious side effects, and the most common was a short-lived headache. And when participants were asked to guess which treatment they took, no group succeeded better than by chance, which showed that the blinding worked.

Tommy Van Brocklin, a 60-year-old Tennessee resident, was not involved in the current trial. But last September, he flew to California to attend SNT at Stanford as part of the team’s ongoing research. Brocklin has been battling depression since he was a child. And although he experienced significant relief in later life from the antidepressant Paxil, its benefits to him declined over time. This year, he began to experience constant suicidal thoughts.

“On the third day, everything started to develop. And it got better and better in the next few days, “Brocklin told Gizmodo about his experience with SNT. “I’ve been home since mid-September and all the benefits have stayed with me, and I feel much better. I sleep; I’m not suicidal anymore. I just have a different view of the world and my life, in a positive way. ”

Although the results were again based on the small sample size, a provisional analysis of the study found that the difference in success rate was so large that it would not be necessary to continue the study. The authors note that there have been other studies of similar size testing new therapies for treatment-resistant depression, including ketamine (a version now approved by the FDA).

“We were pleasantly surprised that this was more powerful, statistically, than we expected. And then we felt it was important to stop the trial and bring out the information as soon as possible, ”Williams said. By the way, the trial was completed in early 2020, just before the covid-19 pandemic began in earnest and temporarily closed the group’s lab anyway.

The very scale of success observed in their studies so far makes the group convinced that their treatment is the right thing to do. Noticeably, it may even surpass electroconvulsive therapy, the most widespread form of brain stimulation for treatment-resistant depression, but one that requires general anesthesia and a complete medical team. And since SNT can be done over the course of a week, they argue, it could serve as a kind of rescue therapy for patients in crisis, allowing them to recover immediately and then switch to other maintenance treatments such as medication or talk therapy (most approved treatments, including antidepressants, may take months to take effect).

In the future, Williams does not rule out the possibility that a version of SNT could be used as a maintenance treatment. Anecdotally, he notes that patients can show continuous improvement after a five-day session for weeks to years, and that patients whose symptoms return may still benefit from additional courses.

Although SNT is a modified version of rTMS, Williams says their technique is indeed a new application. The research group has obtained patents for SNT and is seeking FDA approval. They also received a breakthrough mark from the FDA — a mark indicating that the FDA will expedite the review of something promising in the treatment of a serious condition.

The authors acknowledge that it would be necessary to conduct increasing SNT studies before this treatment could be widely used, which could include direct comparisons with other forms of brain stimulation. But for now, both the team and their patients are hoping for the potential of this treatment.

“I started to get to the point where I was getting very, very frustrated, and I was thinking of giving up.” said Brocklin. “So that was really one of the best things about the treatment – that it helped so quickly.”

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