AI News, Brain stimulation reduces suicidal thinking in people with hard-to-treat depression

Brain stimulation reduces suicidal thinking in people with hard-to-treat depression

'This is one of the first large studies showing rTMS is effective in treating suicidal ideation,' says Dr. Jeff Daskalakis, senior author of the study and Co-Director of the Temerty Centre for Therapeutic Brain Intervention in CAMH's Campbell Family Mental Health Research Institute.

The promising findings give hope that, with further evidence, rTMS may offer a new way to prevent suicide in people with hard-to-treat depression, as well as other mental illnesses.

While medications and psychotherapy are effective treatments for many people with mental illnesses, there's an urgent need for new treatments that quickly and specifically reverse suicidal thinking.

Participants were randomized to receive rTMS in one of three ways: to both the right and left frontal lobes (bilateral rTMS), the left frontal lobe only (unilateral rTMS) or, as a comparison group, sham rTMS, which is similar to a placebo.

While left unilateral rTMS is the most common type, the findings suggest that targeting the right frontal lobe may be key to treating suicidal thinking, says Dr. Weissman, first author of the study.

Given that suicidal thinking occurs across multiple mental illnesses, identifying an effective treatment may prevent suicide for a broad spectrum of people with mental illnesses.

Brain stimulation can effectively reduce suicidal thoughts in depressed people

Toronto: A specific kind of brain stimulation may be effective in reducing suicidal thinking in people with hard-to-treat depression, as well as other mental illnesses, according to a study.

Forty per cent of people in the study, published in The Journal of Clinical Psychiatry, reported that they no longer experienced suicidal thoughts after receiving bilateral repetitive transcranial magnetic stimulation (rTMS).

The findings give hope that, with further evidence, rTMS may offer a new way to prevent suicide in people with hard-to-treat depression, as well as other mental illnesses, researchers said.

Participants were randomised to receive rTMS in one of three ways: to both the right and left frontal lobes (bilateral rTMS), the left frontal lobe only (unilateral rTMS) or, as a comparison group, sham rTMS, which is similar to a placebo.

Brain Stimulation Therapies

Vagus nerve stimulation (VNS) works through a device implanted under the skin that sends electrical pulses through the left vagus nerve, half of a prominent pair of nerves that run from the brainstem through the neck and down to each side of the chest and abdomen.

The pulses appeared to alter the levels of certain neurotransmitters (brain chemicals) associated with mood, including serotonin, norepinephrine, GABA and glutamate.

In 2005, the U.S. Food and Drug Administration (FDA) approved VNS for use in treating treatment-resistant depression in certain circumstances: According to the FDA, it is not intended to be a first-line treatment, even for patients with severe depression.

And, despite FDA approval, VNS remains an infrequently used because results of early studies testing its effectiveness for major depression were mixed.

But a newer study, which pooled together findings from only controlled clinical trials, found that 32% of depressed people responded to VSN and 14% had a full remission of symptoms after being treated for nearly 2 years.

Can magnets cure depression?

Now 61, the retired police lieutenant from Columbus, Ohio, has seen clinical psychologists and psychiatrists and taken antidepressant medication for most of the last three decades.

In 2007, desperate for a new option, she flew to Atlanta for a therapy that, at the time, was still experimental: transcranial magnetic stimulation, or TMS.

The following year, in 2008, the Food and Drug Administration (FDA) approved TMS as a treatment for people with major depression who have failed to respond to at least one antidepressant.

But plenty of questions about TMS still linger, including how best to deliver it, which patients make the best candidates and even what, exactly, the device is doing in the brain.

'I think it's a promising treatment,' says William McDonald, MD, a psychiatrist at Emory University School of Medicine who was involved in the clinical trials that led to the approval of the NeuroStar device.

The pulses are centered over the left prefrontal cortex, an area that often shows abnormal electrical activity in depressed patients.

A typical course of TMS therapy involves 20 to 30 sessions, generally given in three to five treatments per week for four to six weeks.

During the treatments, patients remain awake and alert, seated in a chair while a physician or a nurse places the device against the scalp.

TMS has become a promising treatment alternative for the estimated 30 percent to 50 percent of people with depression who don't respond sufficiently to antidepressant medications.

One option commonly offered to such patients is electroconvulsive therapy (ECT), a procedure in which electrical currents are sent through the brain to trigger a short seizure.

'The theory is that when this stimulation occurs in the left frontal brain, it spreads to the underlying deeper areas of the brain that are involved in regulation of mood.

Those who received TMS were four times as likely to achieve remission as compared with patients who received a sham treatment, the researchers found (Archives of General Psychiatry, 2010).

The results were fairly modest, however — about a 30 percent remission rate for TMS at the end of the full six weeks, compared with perhaps 60 percent for ECT, George says.

Across 42 TMS clinics in the United States, they found that 58 percent of patients showed improvement, including 37 percent who achieved full remission (Depression and Anxietyufzcdtqqeybx, 2012).

While the NIH-sponsored trial found about two in 10 patients experienced remission following TMS, George, Pandurangi, and Schabbing all say they've seen higher remission rates among the patients they've treated.

Some of the patients who responded positively to TMS have experienced remissions lasting months or even years, but follow-up booster sessions every few weeks or months may help prevent a relapse.

There's some evidence the total amount of brain stimulation is what matters, rather than the number of calendar days spent in treatment, George says.

They experienced no serious side effects from the rapid-fire course of treatment, George says, and those who received TMS showed more improvements on the first day than did control subjects who received a sham treatment (Brain Stimulation, 2014).

'They got unsuicidal very quickly,' George says — though he acknowledges that more research and larger samples are required to fully test the approach.

While many questions remain, scientists who study the device say it's a valuable tool for psychologists to keep in mind when referring patients with difficult-to-treat depression.

Others are studying TMS as a possible treatment for disorders including schizophrenia, attention deficit-hyperactivity disorder and post-traumatic stress disorder.

Data suggests TMS could be helpful in treating both acute pain and chronic pain conditions such as fibromyalgia — but to date, no companies have sought FDA approval for that use, he adds.

For instance, preliminary research suggests patients might experience greater improvements if they receive TMS while simultaneously undergoing cognitive-behavioral therapy, George says.

If this line of research pans out, psychologists could play an important role by providing psychosocial therapy while patients are in the TMS chair.

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