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An experimental depression treatment uses electric currents to bring relief

An experimental depression treatment uses electric currents to bring relief

Eleanor Cole, Ph.D., demonstrates the treatment on trial participant Deirdre Lehman in May 2019 at the Stanford Brain Stimulation Lab.
Steve Fisch for Stanford Medicine

After 40 years of fighting debilitating depression, Emma was on the brink.

“I was suicidal,” said Emma, a 59-year-old Bay Area resident. NPR is not using her full name at her request because of the stigma of mental illness. “I was going to die.”

Over the years, Emma sat through hours of talk therapy and tried numerous anti-depression medications “to have a semblance of normalcy.” And yet she was consumed by relentless fatigue, insomnia and chronic nausea.

Depression is the world’s leading cause of disability, partly because treatment options often result in numerous side effects or patients do not respond at all. And there are many people who never seek treatment because mental illness can carry heavy stigma and discrimination. Studies show untreated depression can lead to suicide.

Three years ago, Emma’s psychiatrist urged her to enroll in a study at Stanford University School of Medicine designed for people who had run out of options. On her first day, scientists took an MRI scan to determine the best possible location to deliver electrical pulses to her brain. Then for a 10 minute block every hour for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain.

At the end of the first day, an unfamiliar calm settled over Emma. Even when her partner picked her up to drive home, she stayed relaxed. “I’m usually hysterical,” she said. “All the time I’m grabbing things. I’m yelling, you know, ‘Did you see those lights?’ And while I rode home that first night I just looked out the window and I enjoyed the ride.”

The remedy was a new type of repetitive transcranial magnetic stimulation (rTMS) called “Stanford neuromodulation therapy.” By adding imaging technology to the treatment and upping the dose of rTMS, scientists have developed an approach that’s more effective and works more than eight times faster than the current approved treatment.

A coil placed on top of Emma’s head created a magnetic field that sent electric pulses through her skull to tickle the surface of her brain. She says it felt like a woodpecker tapping on her skull every 15 seconds. The electrical current is directed at the prefrontal cortex, which is the part of the brain that plans, dreams and controls our emotions.

“It’s an area thought to be underactive in depression,” said Nolan Williams, a psychiatrist and rTMS researcher at Stanford. “We send a signal for the system to not only turn on, but to stay on and remember to stay on.”

Williams says pumping up the prefrontal cortex helps turn down other areas of the brain that stimulate fear and anxiety. That’s the basic premise of rTMS: Electrical impulses are used to balance out erratic brain activity. As a result, people feel less depressed and more in control. All of this holds true in the new treatment — it just works faster.

A recent randomized control trial, published in The American Journal of Psychiatry, shows impressive results are possible in five days of treatment or less. Almost 80% of patients crossed into remission — meaning they were symptom-free within a month. This is compared to about 13% of people who received the placebo treatment.

For the control group, the researchers disguised the treatment with a magnetic coil that mimicked the actual treatment. Neither the scientist administering the procedure nor the patients knew if they were receiving the real or sham treatment. Patients did not report any serious side effects. The most common complaint was a light headache.

Stanford’s new delivery system may even outperform electroconvulsive therapy, which is the most popular form of brain stimulation for depression, but while quicker, it requires general anesthesia.

“This study not only showed some of the best remission rates we’ve ever seen in depression,” said Shan Siddiqi, a Harvard psychiatrist not connected to the study, “but also managed to do that in people who had already failed multiple other treatments.”

Siddiqi also said the study’s small sample size, which is only 29 patients, is not cause for concern.

“Often, a clinical trial will be terminated early [according to pre-specified criteria] because the treatment is so effective that it would be unethical to continue giving people placebo,” said Siddiqi. “That’s what happened here. They’d originally planned to recruit a much larger sample, but the interim analysis was definitive.”

Nolan Williams demonstrates the magnetic brain stimulation therapy he and his colleagues developed, on Deirdre Lehman, a participant in a previous study of the treatment.

Steve Fisch for Stanford Medicine

Mark George, a psychiatrist and neurologist at the Medical University of South Carolina, agrees. He points to other similarly sized trials for depression treatments like ketamine, a version of which is now FDA-approved.

He says the new rTMS approach could be a game changer because it’s both more precise and kicks in faster than older versions. George pioneered an rTMS treatment that was approved by the federal Food and Drug Administration for depression in 2008. Studies show that it produces a near total loss of symptoms in about a third of patients; another third feel somewhat better and another third do not respond at all. But the main problem with the original treatment is that it takes six weeks, which is a long time for a patient in the midst of a crisis.

“This study shows that you can speed it all up and that you can add treatments in a given day and it works,” said George.

The shorter treatment will increase access for a lot of people who cannot get six weeks off work or cover child care for that long.

“The more exciting applications, however, are due to the rapidity,” said George. “These people [the patients] got unsuicidal and undepressed within a week. Those patients are just clogging up our emergency rooms, our psych hospitals. And we really don’t have good treatments for acute suicidality.”

After 45 years of depression and numerous failed attempts to medicate his illness, Tommy Van Brocklin, a civil engineer, says he didn’t see a way out.

“The past couple of years I just started crying a lot,” he said. “I was just a real emotional wreck.”

So last September, Van Brocklin flew across the country from his home in Tennessee to Stanford, where he underwent the new rTMS treatment for a single five-day treatment. Almost immediately he started feeling more optimistic and sleeping longer and deeper.

“I wake up now and I want to come to work, whereas before I’d rather stick a sharp stick in my eye,” said Van Brocklin. “I have not had any depressed days since my treatment.”

He is hopeful the changes stick. More larger studies are needed to verify how long the new rTMS treatment will last.

At least for Emma, the woman who received Stanford’s treatment three years ago in a similar study, the results are holding. She says she still has ups and downs but “it’s an entirely different me dealing with it.”

She says the regimen rewired her from the inside out. “It saved my life, and I’ll be forever grateful,” said Emma over the phone, her voice cracking with emotion. “It saved my life.”

Stanford’s neuromodulation therapy could be widely available by the end of this year — that’s when scientists are hoping FDA clearance comes through. The technology is licensed to Magnus Medical, a startup with plans to commercialize it.

Williams, the lead researcher at Stanford, says he’s optimistic insurance companies will eventually cover the new delivery model because it works in a matter of days, so it’s likely more cost-effective than a conventional 6 week rTMS regimen. Major insurance companies and Medicare currently cover rTMS, though some plans require patients to demonstrate that they’ve exhausted other treatment options.

The next step is studying how rTMS may improve other mental health disorders like addiction and traumatic brain injury.

“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we’re finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we’ll supplement the conventional chemical imbalance and psychological conflict models with a new brain circuit model.”

In other words, electricity in the form of rTMS could become one of the vital tools used to help people with mental illness.

Blog author: npr.org

Treating Depressions with TMS

Treating Depressions with TMS

Transcranial Magnetic Stimulation or TMS, is a non-invasive, and effective treatment for depression without the multiple side effects caused by medication treatment. Hear from a patient who says it changed her life. Call the Central California TMS Center for more information.
Medication-free Interventions for Depression

Medication-free Interventions for Depression


Medication-free Interventions for Depression

These treatments have been proven to be effective for mood disorders and are backed by scientific research:



1. Exercise

The last thing a depressed person wants to do is exercise but it is well known that regular physical activity elevates the mood and provides a sense of well being. This is done in part by increasing certain brain neurotransmitters and in part by modulating stress response.





2. Bright Light Therapy (BLT)

This refers to the use of bright light to treat symptoms of depression. Sleep disturbance is a core symptom of depression and of other mood disorders. BLT helps regulate the circadian rhythm, It triggers and increases the amplitude of melatonin production as well as higher serotonin levels. Sleep regulation helps the depressed person start to feel better.






4. Behavioral activation Therapy (BAT)

This behavioral component of CBT has been found to be a “stand alone” treatment for depression and it is highly effective.It guides the person to understand that their emotions are the result of their actions. It helps the depressed person to identify activities that add meaning to their life, like reading, listening to music, volunteering, visiting with friends and family, etc. The person is told to do these things without waiting for their mood to get better.





6. Transcranial Magnetic Stimulation (TMS)

During TMS treatment a large magnetic coil is held against the scalp on the Left Prefrontal Region of the brain. This area is near what is thought to be the “mood center”. Without pain, magnetic pulsations pass through the skull to stimulate the nerve cells. TMS helps normalize the activity of brain circuits involved in depression. The treatment is not invasive and there is no need for an anesthetic. In October, 2008 the US Food and Drug Administration cleared the first TMS device for the treatment of Major Depression




3.Cognitive Behavioral Therapy (CBT)

This is a type of “talk” therapy but also a “do” therapy relying in the delegation of “tasks” to the patient. It focuses on changing negative thought patterns, on learning to redefine problems and on finding new ways to approach them





5. Mindfulness Training

People are told to pay attention in a particular way: to do it on purpose, in the present moment, and without judging. They are thought to bring their mind to mundane objects or activities in everyday life. You practice mindfulness by eating mindfully, walking mindfully, “observing” your breathing, connecting with your senses, resting between actions, listening attentively with mind and heart and “getting lost” in doing what you love.


Glutamate Levels May Predict Outcomes of Patients at Risk of Psychosis

Glutamate Levels May Predict Outcomes of Patients at Risk of Psychosis

Changes in hippocampal function are believed to play a role in the onset of psychosis. A study published today in JAMA Psychiatry suggests that the concentration of the neurotransmitter glutamate and several other metabolites in the hippocampus may offer clues about patients who are most likely to transition to psychosis.

The findings suggest that measuring hippocampal metabolites could help psychiatrists better predict outcomes in patients at risk of developing psychosis.

For the study, Matthijs G. Bossong, Ph.D., of the University Medical Center Utrecht in the Netherlands and colleagues used an imaging technique known as proton magnetic resonance spectroscopy (1 H-MRS) to measure baseline levels of glutamate and several other metabolites in 86 individuals at high risk for psychosis and 30 healthy controls. On the day of the scanning, the researchers used several scales to assess the participants’ functioning as well as symptoms of anxiety and depression. About 18.5 months later, the researchers met face to face with 57 of the 86 participants in the high-risk group to assess whether the patients had transitioned to psychosis; they also assessed the overall functioning in this group.


Psychosis - Clinical depression Fresno

In total, 12 people in the clinical high-risk group experienced a first episode of psychosis; 19 showed “good overall functioning” (Global Assessment of Function, or GAF, scale equal to or greater than 65), whereas 38 of the 57 had “poor functional outcome” (GAF less than 65), Bossong and colleagues reported. The group of patients who transitioned to psychosis were found to have had significantly higher hippocampal glutamate levels at the start of the study than those patients who did not transition. These patients also had significantly higher levels of the metabolites myo-inositol and creatine than those who did not develop psychosis. Moreover, patients with higher levels of hippocampal glutamate at baseline were found to have lower levels of overall functioning at follow-up, the authors reported.

“The findings indicate that adverse clinical outcomes in individuals at high risk for psychosis may be associated with an increase in baseline hippocampal glutamate levels, as well as an increase in myo-inositol and creatine levels,” the authors wrote.

“Pharmacological treatments that engage glutamatergic targets have been generally unsuccessful for treatment of psychotic, negative, and cognitive symptoms of schizophrenia,” Juan R. Bustillo, M.D., of the University of Mexico and colleagues wrote in an accompanying editorial. “However, because schizophrenia is highly heritable and glutamatergic-associated genes are among the most involved, in vivo glutamate measurements may still assist the delineation of subgroups of patients with vulnerable disease stages.”


Source: American Psychiatric Association

The Biology of Mental health

The Biology of Mental health

mental health clinical depression fresno

It has been established with certainty that regular exercise (aerobic or anaerobic) is beneficial to one’s overall health. This is especially true if combined with a regimen that includes a balanced diet with plenty of fruit ,nuts and vegetables.
Lately, there has been a series of studies linking physical exercise to improvement of mood and mental health. It has been known for a long time that Tai Chi exercises and Yoga movements and poses improve balancing, muscle strength and flexibility with the concomitant benefit of an improvement of anxiety and depression. More recently the understanding of the relationship of multiple internal body systems with the brain has shown there are specific benefits from physical exercise to achieve and maintain better mental
health. One of the benefits comes from the “neutralization” of stress during physical exercise. This effect is related to a better autonomic nervous system regulation of the heart function as well as modulation of the body’s inflammatory response (HPA axis). Major depression and anxiety by virtue of their pro-inflammatory status cause to endothelial dysfunction that ultimately lead to “arterial stiffness”. The association between depression and cardiovascular disease is bi-directional. Both entities share common pathophysiology. Following a myocardial infarction the presence of depression has a cumulative effect on morbidity and mortality. At Central California TMS Centers in California and in Guatemala we emphasize lifestyle modifications as part of a comprehensive treatment plan. These key changes include: to achieve a BMI 25% or under, exercise regularly, do yoga or Tai Chi, smoking cessation, reduce alcohol intake, modify or better manage stressful conditions, change diet to one low in carbohydrates, with plenty of vegetables, nuts and fruits.