Sun. Nov 28th, 2021


A magnetic resonance imaging machine.  MRI scans are used to customize the patient's brain stimulation.

A magnetic resonance imaging machine. MRI scans are used to customize the patient’s brain stimulation.
Pictures: Aline Jocard / AFP (Getty Images)

Stanford researchers believe they have developed an effective and fast-acting way to treat difficult cases of depression by improving already approved forms of brain stimulation. In a new trial published this week, researchers found that about 80% of patients improved after going through treatment – much higher rates than those who were given sham placebos.

There is stimulation of the brain Rise As a promising way to deal with depression, especially depression that did not respond to other treatments. The key idea behind this is to use electrical impulses to balance the irregular brain activity associated with neurological or mental disorders. There are different forms of stimuli, the intensity of which varies and how they interact with the body. Some require permanent implants in the brain, others can be used immunologically, such as repetitive transcranial magnetic stimulation (RTMS). As the name implies, rTMS depends on the magnetic field that is temporarily applied to the head.

rTMS has been approved by the Food and Drug Administration since 2008 for patients who do not respond to at least one other treatment. However its success rate is modest with 14% to 30% of patients Experience A significant apology. And although it is safe and requires less maintenance than other types of stimuli, a typical single course takes about six weeks to complete, which is less than the norm for patients with an emergency depression episode.

In recent years, scientists at the Stanford University School of Medicine have been trying to improve RTMS. Their strategy, now known as Stanford Neuromodulation Therapy (SNT), relies on high-dose magnetic pulses delivered over a fast, five-day schedule, which means mimicking the standard rTMS treatment of about seven months. Treatment is personalized for each patient, MRI scans are used in advance to select the best possible locations of the brain to deliver these pulses.

“We were very interested in trying to solve mental problems in an emergency setting, where we were treating people on a day-to-day basis. And so we came up with a way, based on the principles of human neuroscience, to narrow the stimulus from a six-week schedule to one day, ”Nolan Williams, an assistant professor of psychiatry and behavioral science at Stanford, told Gizmodo. Phone

Last year, Williams and his team released a Small study Of the 21 patients who were given SNT, 90% showed that they were severely affected by depression – in other words, they no longer met the criteria for an acute depression episode. Moreover, people’s feelings about the idea of ​​suicide are gone. The study was open label, though, which meant patients and physicians knew what was being treated. More rigorous testing is needed to make sure any medication or treatment actually works, such as a double-blinded and placebo-controlled test. And what the team has now done is publish their new test results in the American Journal of Psychiatry.

Clearly, finding a placebo for brain stimulation is not as easy as telling people to take sugar pills in a simple drug test. Instead, patients will go through a sham stimulation session, where the procedure is performed in such a way that patients feel like they are being stimulated, but in fact only a weak or no pulse is used. In this new trial, 29 participants with treatment-resistant depression were randomized to receive real SNT or SAM. Later, they were monitored for four weeks.

During this time, approximately 78% of patients experienced actual SNT remission, based on standard diagnostic tests, compared to about 13% of the SAM group. There were no serious side effects, the most common being a short-lived headache. And when participants were asked to guess which treatment they received, no team did better than the opportunity, indicating that blindness worked.

Tommy Van Brooklyn, a 60-year-old Tennessee resident, was not involved in the current trial. But this past September, he moved to California to take SNT at Stanford as part of an ongoing study by the team. Brooklyn has struggled with depression since childhood. And although he experienced significant relief from the antidepressant pixel in later life, its benefits for him have steadily diminished over time. This year, he began to constantly feel the idea of ​​suicide.

“By the third day, everything started. And over the next few days it got better and better,” Brooklyn told Gizmodo about her experience with SNT. “I’ve been home since about mid-September now and all the facilities are with me and I feel much better. I’m sleeping; I am no longer suicidal. I have a different view of the world and my life in a positive way. “

Although the results are again based on the size of a small sample, an interim analysis of the trial determined that the difference in success rates was so great that it would be unnecessary to continue the study. And the authors noted that there have been other trials of the same size to test new therapies for treatment-resistant depression, including ketamine (a version of which is now FDA-approved).

“We were pleasantly surprised that it was statistically stronger than we expected. And then we felt it was important to close the trial and get the information out as soon as possible, “said Williams. .

The sheer scale of the success observed so far in their research makes the team confident that their treatment is the real deal. Significantly, it may even surpass electroconvulsive therapy, the most widely used form of brain stimulation for treatment-resistant depression, but requires general anesthesia and a full medical team. And since SNT can be done within a week, they argue, it could serve as a kind of rescue therapy for patients in crisis, allowing them to get better immediately and then transfer to other maintenance treatments such as medication or talk therapy (most allowed). Treatment, including antidepressants, may take several months to become effective).

In the future, Williams does not rule out the possibility that a version of the SNT itself could be used as a maintenance treatment. Annotated, he notes that patients may show continued improvement from week to year from a five-day session and that patients who return to symptoms may still benefit from the additional course.

Although SNT is a modified version of rTMS, Williams says their strategy is really a fancy application of it. The research group has received a patent for SNT, and they are seeking FDA approval. They also received a landmark title from the FDA – a label indicating that the FDA would expedite a review of anything that promises to treat a serious condition.

The authors acknowledge that more and larger trials of SNT need to be conducted before the widespread use of this treatment can be seen, which may include direct comparisons with other forms of brain stimulation. For now, however, both the team and their patients are optimistic about the possibility of this treatment.

“I started to get to a point where I was very, very frustrated and I thought about giving up.” Says Brooklyn. “So it was really one of the best things to treat – it happened to help so quickly.”



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