TMS Research

We are posting this article because it supports our observation that some patients who struggle with treatment-resistant depression and seek alternative treatments such as TMS and ketamine may have a bipolar-spectrum illness rather than major depression. It is a reminder that every patient who presents to TMS and ketamine providers with treatment-resistant depression should be properly screened for bipolar disorder. If a careful history reveals that a diagnosis of bipolar disorder is appropriate, then treatment recommendations such as the addition of mood stabilizers and second-generation antipsychotics, and discontinuation of traditional antidepressants should be considered.

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Depression is the leading cause of disability worldwide, and half of patients with depression have treatment-resistant depression. Intermittent theta-burst stimulation (iTBS) is approved by the U.S. Food and Drug Administration for the treatment of treatment-resistant depression but is limited by suboptimal efficacy and a 6-week duration. The authors addressed these limitations by developing a neuroscience-informed accelerated iTBS protocol, Stanford neuromodulation therapy (SNT; previously referred to as Stanford accelerated intelligent neuromodulation therapy, or SAINT). This protocol was associated with a remission rate of ∼90% after 5 days of open-label treatment. Here, the authors report the results of a sham-controlled double-blind trial of SNT for treatment-resistant depression.

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This study evaluates an accelerated schedule of theta-burst stimulation using a transcranial magnetic stimulation device for treatment-resistant depression. In a double-blind fashion, half the participants will receive accelerated theta-burst stimulation while half will receive sham treatment.

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Both transcranial magnetic stimulation (TMS) and infused ketamine are recognized treatments for patients suffering from major depressive disorder (MDD). A novel therapy named combination TMS with ketamine (CTK) is introduced. This retrospective review examined the safety and clinical benefits of CTK in patients suffering from treatment-resistant depression (TRD) during the routine practice of psychiatry in a private clinic.

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Therapeutic neuromodulation takes advantage of the brain’s electrochemical makeup. This allows for treatment devices that modulate neurocircuits relevant to behaviors disrupted in disorders such as major depressive disorder (MDD) (eg, sleep quality, appetite, cognitive, and executive functions). The default mode network (comprised of structures such as the medial prefrontal cortex [MPFC], the posterior cingulate cortex, the hippocampus, and their functional connectivity) serves as a prime example of circuitry that can be targeted by this approach.

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Depression following a traumatic brain injury (TBI) is common and difficult to treat using standard approaches. The current study investigated, for the first time, transcranial magnetic stimulation (TMS) for the treatment of post TBI depression. We specifically assessed the safety, tolerability, and efficacy of TMS in this patient population. We also explored cognitive outcomes. Twenty-one patients with a current episode of major depression subsequent to a TBI participated in a randomized double-blind placebo-controlled trial of repetitive TMS (rTMS).

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Nearly half of all patients with Traumatic Brain Injury (TBI) history meet criteria for Major Depressive Disorder (MDD). Often, MDD is resistant to psychopharmacological treatment and psychotherapy. Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive, FDA-cleared treatment for such treatment resistant depression (TRD). Despite its safety and efficacy, there has been limited investigation into its potential for treating depression comorbid to mild to moderate TBI.

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The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment resistant patients (at least 4 medication trials) appears to be well accepted and forms the coverage policies and rTMS’s use in many of the largest US payers. However, less is known about rTMS’s use in patients who have undergone ≤1 failed medication trial. The purpose of this analysis was to determine the clinical efficacy of rTMS in patients after ≤1 medication trials.

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Open-label transcranial magnetic stimulation (TMS) reduced suicidal ideation in adolescents with treatment-resistant depression, according to the results of a study published in the Journal of Affective Disorders.

Suicide is a leading cause of death among adolescents worldwide.

In the United States, nearly 20% of adolescents [KL1] consider suicide, 15% have formulated plans for suicide, and almost 10% attempt suicide annually. Despite efforts to reduce suicide, the rate of suicide attempts and successful suicide continues to increase in the United States. Early attempts also predict similar behavior in adulthood.

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The effect of an acute course of high-frequency repetitive Transcranial magnetic stimulation (TMS) on suicidal ideation in adolescents was examined in this exploratory study. Researchers obtained data from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression . . . Findings revealed that in adolescents, open-label TMS alleviated suicidal ideation through the treatment and improvement of depressive symptom severity.

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Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method increasingly used to treat psychiatric disorders, primarily depression. Initial studies suggest that rTMS may help to treat addictions, but evaluation in multicenter randomized controlled trials (RCTs) is needed. We conducted a multicenter double-blind RCT in 262 chronic smokers meeting DSM-5 criteria for tobacco use disorder, who had made at least one prior failed attempt to quit, with 68% having made at least three failed attempts.

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Deep, repetitive transcranial magnetic stimulation (TMS) is safe and effective in decreasing symptoms of alcohol addiction and brain reactivity, new research suggests.

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There is no clinical consensus on the optimal protocol for the treatment of major depressive disorder (MDD) using repetitive transcranial magnetic stimulation (rTMS). Accelerated protocols using more than a single session of treatment per day have been suggested as a means to reduce the overall length of time required for rTMS therapy. The objective of this study is to compare the treatment outcomes of patients with MDD who received two sessions of rTMS per day vs those who received one session per day, keeping the overall number of delivered pulses constant.

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A 19-year-old white man was referred to us for treatment of OCD with rTMS. Early, albeit mild, signs of OCD were present during adolescence. His present history started in April 2014 when, following emotional stress, he developed increasingly complex obsessions and lengthy compulsions. He spent hours touching a wall until someone said the “right words” to him, and he festinated for hours on floor lines, which made walking impossible..

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Recent findings indicate that the motor and premotor cortices are hyperexcitable in obsessive-compulsive disorder (OCD). The authors have performed the first randomized, double-blind clinical trial of repetitive transcranial magnetic stimulation (rTMS) in OCD, with a 3-month follow-up. OCD patients (N=22) were assigned to either 2 weeks of active or sham rTMS to the supplementary motor area bilaterally. After 14 weeks, the response rate was 41% (7/12) with active and 10% (1/10) with sham treatment. At 14 weeks, patients receiving active rTMS showed, on average, a 35% reduction on the Y-BOCS, as compared with a 6.2% reduction in those receiving sham treatment.

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A study published in the Journal of Affective Disorders demonstrated the cognitive safety of H1-coil transcranial magnetic stimulation (TMS) treatment for individuals with bipolar depression.

The exploratory study sought to evaluate the effects of H1-coil TMS treatment on 6 cognitive domains (attention and processing speed, inhibitory control, working memory and executive function, language, immediate verbal memory, and long-term verbal memory) in subjects with bipolar depression.

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The presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders.

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Stanford Medicine researchers used high doses of magnetic stimulation, delivered on an accelerated timeline and targeted to individual neurocircuitry, to treat patients with severe depression.

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Magnetic stimulation of the brain improves working memory, offering a new potential avenue of therapy for individuals living with Alzheimer’s disease and other forms of dementia, according to a study published in PloS One.

In the study, healthy younger and older adult participants who received repetitive transcranial magnetic stimulation (rTMS) performed better on a memory task than during an rTMS-like placebo.

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Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive treatment approved by the U.S. Food and Drug Administration for the treatment of clinical depression. The treatment is also being studied as a potential therapy for Alzheimer’s disease.

How rTMS works:
Alzheimer’s disease is the most common cause of dementia, affecting millions of mostly elderly people around the world. In these people, the synaptic activity (connections between nerve cells) collapses and brain networks gradually falter, resulting in a decline in memory and the ability to think and learn.

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The US Food and Drug Administration (FDA) has approved a new magnetic stimulation device that is designed to treat patients with treatment-resistant major depressive disorder (MDD) in just 3 minutes.

The Express Transcranial Magnetic Stimulation (TMS) device, from MagVenture, has been approved by the FDA—expediting the treatment session speed set only by the company’s preceding TMS device when it was first cleared in 2008. What was once a treatment regimen that required patients with MDD to undergo a 30-minute-plus session 20-30 times, is now capable of being completed in just 3 minutes per session.

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Intermittent theta burst stimulation, a shorter version of the 37-minute repetitive transcranial magnetic stimulation that can be delivered in 3 minutes, was noninferior to the longer version for treatment-resistant depression, findings published in The Lancet revealed.

“Several pilot trials and two meta-analyses indicate that [intermittent theta burst stimulation] is superior to sham treatment for treatment-resistant depression. However, the key practical question is whether [intermittent theta burst stimulation] performs comparably to the existing standard of care,” Daniel M. Blumberger, MD,of the department of psychiatry, University of Toronto, and colleagues wrote.

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TORONTO, April 26, 2018 – In the largest study of its kind, a three-minute version of a brain stimulation treatment was shown to be just as effective as the standard 37-minute version for hard-to-treat depression.

These results were published in a new Canadian study in The Lancet co-led by the Centre for Addiction and Mental Health (CAMH) and the University Health Network's Krembil Research Institute, in collaboration with the University of British Columbia.

The treatment is called repetitive transcranial magnetic stimulation (rTMS), which is a form of treatment that uses magnetic field pulses to non-invasively stimulate a part of the brain called the dorsolateral prefrontal cortex, which is associated with mood regulation. The study compared standard rTMS treatment, which uses high frequency (10 Hz) brain stimulation for 37.5 minutes per session, with a newer form of rTMS called intermittent theta burst stimulation (iTBS), that mimics the brain's natural rhythms and takes just over three minutes per treatment.

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