A new type of magnetic brain stimulation rapidly relieved symptoms of severe depression in 90% of treatment-resistant participants in a small study by Stanford University School of Medicine.

The treatment, called Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), is a form of transcranial magnetic stimulation approved by the Food and Drug Administration for the treatment of depression.

The therapy improves on current FDA-approved protocols by increasing the number of magnetic pulses, speeding up the pace of the treatment and targeting the pulses according to each patient’s neurocircuitry.

Before receiving the treatment, all 21 study participants were severely depressed, according to several diagnostic tests for depression. After the treatment, 19 of them scored within the nondepressed range.

Although all of the participants had suicidal thoughts before the therapy, none reported having suicidal thoughts after treatment. All 21 participants had previously not experienced improvements with medications, FDA-approved transcranial magnetic stimulation or electroconvulsive therapy.

The only side effects of the new therapy were fatigue and some discomfort during treatment.

“There’s never been a therapy for treatment-resistant depression that’s broken 55% remission rates in open-label testing,” said Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences and a senior author of the study.

“Electroconvulsive therapy is thought to be the gold standard, but it has only an average 48% remission rate in treatment-resistant depression. No one expected these kinds of results.”

In transcranial magnetic stimulation, electric currents from a magnetic coil placed on the scalp excite a region of the brain implicated in depression. The treatment requires six weeks of once-daily sessions. Only about half of patients who undergo this treatment improve, and only about a third experience remission from depression.

Stanford researchers hypothesized that some modifications to transcranial magnetic stimulation could improve its effectiveness. For example, some research had shown that a stronger dose — 1,800 pulses per session instead of 600 — might be more effective. The team was cautiously optimistic regarding the safety of the treatment, as that dose of stimulation had been used without harm in other forms of brain stimulation for neurological disorders, such as Parkinson’s disease.

Other studies suggested that accelerating the treatment would help relieve patients’ depression more rapidly. With SAINT, the patients in the study were given 10 sessions per day of 10-minute treatments, with 50-minute breaks in between. On average, three days of the therapy were enough for participants to feel relief from depression.

“The less treatment-resistant participants are, the longer the treatment lasts,” said postdoctoral scholar Eleanor Cole, PhD, a lead author of the study.

The researchers also hypothesized that targeting the stimulation more precisely would improve the treatment’s success. In transcranial magnetic stimulation, the treatment is aimed at the location where most people’s dorsolateral prefrontal cortex lies. This region regulates executive functions, such as selecting appropriate memories and inhibiting inappropriate responses.

For SAINT, the team used magnetic-resonance imaging of brain activity to locate not only the dorsolateral prefrontal cortex, but a particular subregion within it. They pinpointed the subregion in each participant that has a relationship with the subgenual cingulate, a part of the brain that is overactive in depression.

In people with depression, the link between the two regions is weak, and the subgenual cingulate becomes overactive, said Keith Sudheimer, PhD, clinical assistant professor of psychiatry and a senior author of the study. Stimulating the subregion of the dorsolateral prefrontal cortex reduces activity in the subgenual cingulate, he said.

To test safety, the researchers evaluated the participants’ cognitive function before and after treatment. They found no negative side effects; in fact, they found that the subjects’ ability to switch between mental tasks and to solve problems had improved — a typical outcome for people who are no longer depressed.

One month after treatment, 60% of the patients were still in remission from depression. Follow-up studies are underway to determine the duration of the antidepressant effects.

The team is conducting a larger, double-blinded trial in which half of the subjects are receiving fake treatment. The researchers are optimistic the second trial will turn out to be similarly effective in treating people whose condition hasn’t improved with medication, talk therapy or other forms of electromagnetic stimulation.

The researchers also plan to study the effectiveness of SAINT on other conditions, such as obsessive-compulsive disorder, addiction and autism spectrum disorders.

The new findings are published in the American Journal of Psychiatry.

Source: Stanford Medicine

Magnetic Brain Stimulation Relieves Symptoms of Severe Depression