27/04/2018
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.
“The main impact of this study is that the
number of people who are able to be treated
using theta burst stimulation compared to the
standard form of rTMS can be increased by three
to four fold,” says lead author Dr. Daniel
Blumberger, Co-Director of the Temerty Centre
for Therapeutic Brain Intervention at CAMH.
“These findings will have a significant impact on
our ability to treat patients,” says Dr. Jonathan
Downar, Co-Director, University Health
Network’s rTMS Clinic; Scientist, Krembil
Research Institute and senior author of the
study. “This will allow every device in Canada to
treat several times more people per day, meaning
shorter wait lists and better access to this
treatment.”
The study, conducted with Dr. Fidel Vila-
Rodriguez, Assistant Professor, University of
British Columbia, focused on people with
treatment-resistant depression, defined as a
condition whereby people do not experience a
sufficient improvement in their symptoms after
trying antidepressant medications. Up to 40 per
cent of people with depression may experience
treatment resistance.
In the study, 414 participants were randomly
allocated to receive either the standard form of
rTMS treatment or the shorter iTBS treatment
for five days a week for up to six weeks.
In the study, 414 participants were randomly
allocated to receive either the standard form of
rTMS treatment or the shorter iTBS treatment
for five days a week for up to six weeks.
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For 49 per cent of study participants who had the
iTBS treatment, depression symptoms reduced
significantly, with 32 per cent reporting a
remission of depression symptoms. Those who
received standard rTMS had a remission rate of
27 per cent. Those results are consistent with
previous large-scale studies and meta-analyses
over the past 20 years that have confirmed the
efficacy and safety of the standard form of
rTMS.
rTMS treatment was approved for treating
depression by Health Canada in 2002 and by the
U.S. Food and Drug Administration in 2008. Due to
the cost of treatment (it is not covered by public
health insurance outside Quebec and
Saskatchewan), it has only been made available
to a fraction of the estimated 600,000 Canadians
living with treatment-resistant depression each
year.
“rTMS has changed my life in so many ways,”
says study participant Shelley Hofer, 43, who has
had treatment-resistant depression for most of
her life. “I really wish it had been around a long
time ago because I believe it would have been my
go-to treatment. In my personal opinion, I feel
rTMS could improve the lives of so many people
who are still struggling to find the answers to
their own mental illness.”
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