A type of therapy that consists of applying a magnetic field to both sides of the brain has proven effective for quickly treat depression in patients for whom standard treatments have proven ineffective.
He treatmentknown as repetitive transcranial magnetic stimulation (EMT), involves placing an electromagnetic coil against the scalp to transmit a high-frequency magnetic field to the brain. It is estimated that one in 20 adults suffers from depression. Although treatments, such as antidepressant medication and cognitive behavioral therapy (‘talk therapy’), exist, they are ineffective for just under one in three patients.
One of the key characteristics of depression is underactivity of some regions (such as the dorsolateral prefrontal cortex) and hyperactivity of others (such as the orbitofrontal cortex [CMO]). Repetitive transcranial magnetic stimulation applied to the left side of the dorsolateral prefrontal cortex (an area in the upper front part of the brain) is approved for the treatment of depression in the United Kingdom by NICE and in the United States by the FDA.
It had previously been shown to produce considerable improvements among patients after a course of 20 sessions, but since the sessions usually last between 20 and 30 days, the treatment is not ideal for everyone, especially in acute cases or when the person is suicidal.
In one research published in ‘Psychological Medicine’, Scientists from Cambridge (United Kingdom) and Guiyang (China) verified the effectiveness of an accelerated form of TMS. In this approach, treatment is administered over 20 sessions, but with four sessions daily over a period of five consecutive days. The researchers also tested a dual approach, in which a magnetic field was also applied to the right side of the CMO (located beneath the dorsolateral prefrontal cortex).
75 patients from the Second People’s Hospital in Guizhou Province, China, participated in the trial. The severity of their depression was measured on a scale known as the Hamilton Rating Scale of Depression.
Participants were randomly divided into three groups: a ‘dual’ group that received TMS applied first to the right and then the left side of the brain; a ‘simple’ group that received sham TMS on the right side followed by active TMS applied on the left side; and a control group that received sham treatment on both sides. Each session lasted a total of 22 minutes.
There was a significant improvement in scores assessed immediately after the final treatment in the dual treatment group compared to the other two groups.
When researchers looked for clinically relevant answers -that is, when an individual’s score decreased by at least 50%-, they observed that almost half (48%) of the patients in the dual treatment group experienced such a reduction, compared to just under one in five (18 %) in the single treatment group and less than one in 20 (4%) in the control group.
Four weeks later, about six in ten participants in the dual and single treatment groups (61% and 59% respectively) showed clinically relevant responsescompared to just over one in five (22%) in the control group.
Professor Valerie Voon, from the Department of Psychiatry at the University of Cambridge, who led the British part of the study, explains that This “accelerated approach means we can reduce the number of participants in the study.”
“Our accelerated approach allows us to complete all sessions in just five days and quickly reduce symptoms of depression. This means it could be especially useful in severe cases of depression, such as when someone has suicidal thoughts, he explains. “It can also help you be discharged from the hospital more quickly or even avoid admission.”
According to him, “the treatment works faster because, by targeting two areas of the brain involved in depression, we are effectively correcting imbalances in two important processes, getting the brain regions to ‘talk’ to each other correctlynte”.
He Treatment was more effective in those patients who at the beginning of the trial showed greater connectivity between the OFC and the thalamus (an area located in the center of the brain responsible, among other things, for the regulation of consciousness, sleep and alertness).
The OFC is important to help make decisions, especially when choosing rewards and avoiding punishments. Its hyperactivity in depression, especially in relation to its role in anti-reward or punishment, could help explain why people with depression show a bias toward negative expectations and rumination.
According to Dr. Yanping Shu of the Guizhou Mental Health Center (Guiyang, China), “this new treatment has shown a more pronounced improvement -and faster- response rates in patients with major depressive disorder.
In his opinion, “it represents an important step forward in improving results, as it allows rapid hospital discharge of people with treatment-resistant depressionand we hope it opens new possibilities in mental health care.”
For his part, Dr. Hailun Cui of Fudan University, a doctoral student in Professor Voon’s laboratory at the time of the study, recalls that “the treatment of treatment-resistant depression remains one of the most difficult areas of mental health care. These patients usually do not respond to usual treatments, such as medication and psychotherapy, which “It leaves them in a prolonged state of severe distress, functional impairment, and increased risk of suicide.”
According to the researchers, patients frequently reported feeling “lighter and brighter” as early as the second day of treatment. The rapid improvements, coupled with a higher response rate that could benefit a broader depressed population, represent a significant advance in this field.
A little less than half (48%) of participants in the dual treatment group They manifested local pain in the place where the dual treatment was applied, compared to just under one in 10 (9%) of participants in the single treatment group. However, despite this, there were no dropouts.
For some individuals, this treatment may be sufficientbut for others ‘maintenance therapy’ may be necessary, with an additional one-day session if their symptoms seem to worsen over time.
It may also be possible to re-administer standard therapy, as patients may then be more able to engage with psychotherapy. Other options are transcranial direct current stimulation, a non-invasive form of stimulation that uses weak electrical impulses and can be administered at home. Researchers are now studying which part of the orbitofrontal cortex is most effective and for which types of depression.
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