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Transcranial Magnetic Stimulation: A Breakthrough in Depression Treatment

5/6/2013

Butler Hospital offers a pioneering, noninvasive way to alleviate depression symptoms


Transcranial magnetic stimulationDepression is among the most common forms of brain based illnesses. According to the World Health Organization, depression affects more than 350 million people of all ages globally. Depression can significantly impair an individual’s family and personal relationships, work and school life. It can also impact their physical well being, as depression is often linked to cardiovascular disease, stroke and chronic pain.

At Butler Hospital, a team led by Linda Carpenter, MD is offering patients a noninvasive way to alleviate their depression symptoms. Carpenter, chief of Butler’s Mood Disorders Program and a professor in the department of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, is researching various devices that deliver transcranial magnetic stimulation (TMS) as a treatment that resets the brain back to its normal non-depressed state. TMS therapy is a series of pulsed magnetic energy fields delivered to conscious patients during noninvasive daily treatment sessions.

The first TMS device with FDA approval for treating a psychiatric disorder - the NeuroStar device manufactured by Neuronetics - uses a single “coil” held in contact with a patient’s head. Carpenter and her colleagues participated in a multicenter, longitudinal, naturalistic, observational study using the NeuroStar device in the Butler Hospital outpatient TMS clinic, proving that acute TMS induced "statistically and clinically meaningful response and remission" in patients with treatment-resistant major depressive disorder (TR-MDD). This was the first study of its kind to show that therapeutic results of TMS are seen in a variety of different practice settings (58% of patients were considered “responders”, and 37% showed complete remission) and that benefits from TMS were largely maintained at 52 weeks.  

With the goal of providing TMS therapy in a patient-customized fashion and with a more portable device, the NeoSync EEG-Synchronized TMS, or “NEST” is currently being studied by Carpenter and colleagues in a controlled clinical trial. The NEST device allows clinicians to read a patient's individual alpha brain wave pattern at the start of a treatment series and delivers a low energy magnetic field that is synchronized to the depressed patient’s individual alpha frequency. Alpha brainwaves are believed to regulate normal brain function, and the sTMS device is thought to bring about clinical improvement through establishing normal brain rhythm patterns in patients with major depression.

Yet another approach - to deliver magnetic energy pulses in a way that may penetrate deeper into the brain - is the focus of a new study that Carpenter and colleagues will soon conduct with a TMS device developed by Cervel Neurotech, Inc. Using two TMS coils positioned on a patient’s head at the same time, this device may offer a higher degree of control over the direction of stimulation in the brain and may enhance the effects of the treatment by using the summed energy produced by two TMS treatment coils instead of one.

The various TMS devices investigated in Carpenter’s lab use the latest technology to stimulate the brain in a safe way that may provide a novel treatment option for those whose depression has not responded to standard medication. However, in addition to its therapeutic application, TMS devices are also considered state-of-the-art tools for conducting research on the human brain.

During the 2012-2013 academic year, Brown University furthered its commitment to brain science, awarding Carpenter and her Brown campus-based research colleagues (David Badre and Jerome Sanes) funding to develop a Brain Stimulation Facility. This core research facility will provide more than twenty brain scientists at Brown access to the latest equipment and techniques for localized, non-invasive, transient brain stimulation in humans: transcranial magnetic stimulation (TMS) and transcranial direct and alternating current stimulation (tDCS and tACS). The inclusion of stereotactic neuronavigation in this core facility will allow Brown investigators to precisely target and stimulate specific, predetermined brain areas.

Non-invasive, focal brain stimulation is an approach that beautifully complements fMRI and EEG as tools for uncovering the roles of specific brain areas in human cognition and the processes that underlie brain disorders.

“It has been such a thrill to be involved in researching novel brain stimulation treatments like Transcranial Magnetic Stimulation (TMS) that really do make their way from the engineering lab into the research clinic, and from the research clinic into mainstream care of patients in our community” Carpenter said. “I feel like we are at the beginning of a huge paradigm shift in how we, as scientists and healthcare providers, will approach common and disabling diseases. In the past we had medications and surgery to combat brain disorders. Now and in the future we will be able to do it effectively and safely through the use of noninvasive interventions that target brain activity with energy fields.”

To learn more about the work of Carpenter and her colleagues, please visit the Mood Disorders Research Program’s Butler Hospital web site, Carpenter’s Brown University web page or call 401-455-6349.