Promising New Treatment for Deppression

[WillBrink]

And without drugs no less. Currently only approved for TR-MDD but looks very promising:

SAN FRANCISCO — Transcranial magnetic stimulation (TMS) appears to offer long-term efficacy in patients with treatment-resistant major depressive disorder (TR-MDD), new research shows.

Presented here at the American Psychiatric Association's 2013 Annual Meeting, the multicenter, longitudinal, naturalistic, observational study showed that acute TMS induced "statistically and clinically meaningful response and remission" in patients with TR-MDD during the acute phase, and that the results were maintained at 52 weeks.

"This is the first study to examine 12-month outcomes of TMS in a large dataset in a real-life setting. We have data on 257 patients that got all the way through the long-term follow-up, and we found that 68% improved and 45% had complete remission at 1 year follow-up," study investigator Linda L. Carpenter, MD, professor, Department of Psychiatry and Human Behavior, Brown University School of Medicine, and chief, Mood Disorders Program, Butler Hospital, in Providence, Rhode Island, told Medscape Medical News.

"I think this will really be impressive for confirming the long-term durability of this effect to potential payers. This is exciting times for psychiatrists and patients, who have a new treatment option to pursue," she added.

Previous research has shown that TMS is a safe and effective acute treatment option for patients with TR-MDD. However, the long-term efficacy and durability of the treatment in this patient population were unclear.

To assess the changes in depressive symptoms and functional capacity across the duration of acute and long-term follow-up of TMS treatment, the investigators studied 307 depressed patients who were part of a prospective multicenter observational clinical trial examining the utilization and outcomes of the NeuroStar TMS Therapy System (Neuronetics Inc, Malvern, Pennsylvania).

Study participants had a primary diagnosis of unipolar, nonpsychotic major depressive disorder and had failed to receive benefit from prior antidepressant treatment. The mean age of the participants was 48.6 ± 14.2 years, and 66.8% were women.

The study's primary outcomes included Clinical Global Impressions–Severity of Illness Scale (CGI-S), Patient Health Questionnaire (PHQ-9), and the Self-Rated Inventory for Depression Symptomatology (IDS-SR).

All patients initially received the standard simulation protocol (120% of motor threshold, 10-Hz cycles of 4 seconds of active stimulation followed by 26 seconds of no stimulation for a total of 3000 pulses per treatment session), but this could change to meet patient needs. Treatment was received daily for a period of 4 to 6 weeks.

Real-world Study

Of the total study population, 264 patients (62%) from 42 clinical practices achieved symptomatic improvement, and 41% reported complete remission with acute treatment.

Of these individuals, 257 entered a 12-month long-term follow-up phase of the study, in which they were tapered off of the acute treatment regimen and were observed for 52 weeks.

Outcome measures were obtained at 3, 6, 9, and 12 months. Concurrent medication use and TMS reintroduction for recurrent symptoms were recorded and summarized during the long-term follow-up.

At 12 months, 68% of patients achieved symptomatic improvement, and 45% reported complete remission. Maintenance of benefit was observed under a pragmatic regimen of continuation antidepressant medication and access to TMS reintroduction for symptom recurrence.

The researchers report that compared with baseline, there was a statistically significant reduction in mean (standard deviation [SD]) CGI-S, PHQ-9, and IDS-SR total scores at the end of acute treatment (5.1 [0.9] vs 3.2 [1.5]; 18.3 [5.2] vs 9.6 [7.0]; and 45.7 [11.0] vs 27.4 [15.8]; all P < .0001), which was sustained throughout the 52-week follow-up period (3.0 [1.5], 9.4 [7.2], and 27.3 [16.1], respectively; all P < .0001).

"The durability of NeuroStar TMS Therapy demonstrated by this robust, real-world study is remarkable, as it's not typical to see long-term benefit in patients who have treatment-resistant forms of depression," study investigator Philip Janicak, MD, professor of psychiatry, Rush University Medical College, and medical director of the Rush Psychiatric Clinical Research Center, in Chicago, said in a statement.

"Great News"

Asked by Medscape Medical News for independent comment on the study, Mark George, MD, professor of psychiatry, radiology, and neurosciences and director of the Medical University of South Carolina Center for Advanced Imaging Research as well as the Brain Stimulation Laboratory in Charleston, said that the study is good news for clinicians and patients alike.

Dr. George's group was the first to publish a study on TMS and depression in 1994, and he has been actively investigating the technology since that time.

He also led a large National Institutes of Health study, published in 2010, showing that repetitive daily TMS produced statistically significant and clinically meaningful antidepressant effects compared with sham treatment in patients with TR-MDD.

"This is a very important and exciting study. Several prior studies have shown that prefrontal rTMS works to treat depression acutely. Until this study, we have had only limited information about how well these patients do a year after completing a course of TMS. Long-term data following remission produced by medications or electroconvulsive therapy [ECT] in these treatment-resistant patients have been disappointing, with only about 13% being still remitted a year later.

"For example, over half of patients who remit with ECT are ill again 6 months later. Thus, having 45% in remission a full year later is very, very encouraging that rTMS is perhaps changing the underlying pathological circuitry associated with depression and producing a more stable remission than the other treatments.

"This is great news for our field and for the millions of patients who suffer from depression and do not respond well to medications," Dr. George added.

Source:

http://www.medscape.com/viewarticle/804736

[montanadave]

This is good news. I hope it pans out. I have a friend who suffers from severe depression which was unresponsive to meds. Watching him struggle for several years while clinicians titrated him on and off virtually every anti-depressant available with no improvement was gut-wrenching. He was prepared to give up (i.e. commit suicide) when they finally tired ECT. It worked but it also caused memory loss and some other side effects.

This TMS protocol sounds much better.

[WillBrink]

This is good news. I hope it pans out.

It's pretty panned out as it's offered at many major hospitals already. Probably the best known psychiatric hospital in the world - McLean's/Harvard - offers it:

http://www.mclean.harvard.edu/patient/adult/tms.php

I have a friend who suffers from severe depression which was unresponsive to meds. Watching him struggle for several years while clinicians titrated him on and off virtually every anti-depressant available with no improvement was gut-wrenching. He was prepared to give up (i.e. commit suicide) when they finally tired ECT. It worked but it also caused memory loss and some other side effects.

This TMS protocol sounds much better.

A google search for places offering TMS should turn up locations in your area or close to it. There's like 4-5 within 30 mins if me, but I live in a very hospital/med dense area of the country. If it works, obviously worth traveling for.

[Vic303]

And then there is ECT (shock treatment). Yes, it does work well in folks per more recent studies.
http://abcnews.go.com/Health/Depress...4199997&page=1

[glocktogo]

This is great news for those suffering from this debilitating condition.

I just wish they could implement a treatment for those of us suffering from sociopolitical depression. Watching Washington DC slide into the Atlantic on a weekday during session would pretty much cure mine.

[WillBrink]

This is great news for those suffering from this debilitating condition.

I just wish they could implement a treatment for those of us suffering from sociopolitical depression. Watching Washington DC slide into the Atlantic on a weekday during session would pretty much cure mine.

[Irish]

The VA is using the Alpha-Stim here at one of the Las Vegas vet centers and has had promising results thus far, especially with depression and PTSD. Just thought I'd throw that out there in case people are looking for other viable options that might help.

[SteveS]

Lets hope it does good as most drugs aren't the best.

[Irish]

Lets hope it does good as most drugs aren't the best.

So far, they've had really good success with the Alpha-Stim. There's also probes you can get, with the upgraded unit, for stimulation at specific spots for dealing with pain as well. I'm helping do some research for them on the physical pain aspect and testing how effective the unit is.

[WillBrink]

So far, they've had really good success with the Alpha-Stim. There's also probes you can get, with the upgraded unit, for stimulation at specific spots for dealing with pain as well. I'm helping do some research for them on the physical pain aspect and testing how effective the unit is.

I'm unclear if the tech you posted is same/similar to the OP, but I can report the tech from the OP has continued to show great promise and it being used with more frequency. I spoke to a few docs who are using it and clinical response is quite good according to them.