The use of transcranial magnetic stimulation (TMS) seems to be effective for the long-term treatment of major depression, according to study conducted by researchers at Rush University Medical Center.
The study, which aimed to determine the durability and long-term effects of TMS as a treatment modality, found that the majority of patients who received the treatment completed two trial phases without relapse. Until this study, there has been limited information on long-term benefits of the therapy.
A non-invasive, non-drug therapy, TMS delivers highly focused magnetic field pulses to a specific portion of the brain — the left prefrontal cortex — in order to stimulate the areas of the brain linked to depression. The pulses are comparable to the magnetic field produced during an MRI imaging scan.
“This is the only prospective, maintenance, follow-up study which assesses the durability of acute TMS benefit in patients with major depression,” said Dr. Philip G. Janicak, study principal investigator and professor of psychiatry at Rush University Medical Center.
Researchers identified 301 patients suffering from major depression for the acute randomized trial. Participants were randomly assigned to receive active or sham TMS in the six-week, controlled trial.
Patients who responded then underwent a three-week transition period where they were tapered off of active or sham TMS treatment and started on a standard antidepressant for maintenance.
The treatment and maintenance phase of the trial represents the typical course of treatment a patient would follow.
The 142 patients who received active TMS therapy were then entered into a three-week transition phase. Of these, 85 percent completed the phase without relapse.
Ninety-nine of those who completed treatment without relapse then agreed to be followed for an additional 24-week period during. During this period, only 10 of the 99 relapsed.
“The results of the follow-up study further support TMS as a viable treatment option for patients with major depression who have not responded to conventional antidepressant medications,” said Janicak. “After acute response to TMS, a standardized regimen of antidepressant medication maintained the acute benefit in the majority of patients over a six-month period.”
Researchers also found that TMS therapy proved successful when used as an intermittent rescue strategy to stop pending relapse in 32 of 38 patients. This finding revealed that reintroducing TMS alongside medication was effective and safe in preventing relapse.
TMS received clearance from the U.S. Food and Drug Administration (FDA) in October 2008. However, it remains an expensive treatment that few practitioners use regularly for the treatment of depression.
Developed by Neuronetics, Inc., the approved TMS device does not require that patients receive anesthesia or sedation during treatment. The outpatient procedure lasts 40 minutes and is typically administered daily for four to six weeks.
Results of the study were published in the October 2010 issue of Brain Stimulation.
Depression affects at least 14 million American adults each year. Researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide. About two thirds of those who experience an episode of depression will have at least one other episode in their lives. Current antidepressant therapies are not beneficial for at least a third of depressed individuals, leaving many with a lack of adequate treatment options.
Source: Rush University Medical Center