We might soon have a reliable treatment for severe depression. New research at the Stanford University School of Medicine reports that a new type of magnetic brain stimulation was successful in treating almost 80% of participants with this condition.
The treatment approach is known as the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), or Stanford neuromodulation therapy for short. It is an intensive, individualized transcranial magnetic stimulation therapy, and it shows great promise against severe depression -- so far, in controlled trials. While effective, there are some side effects to this treatment: temporary fatigue and headaches.
All in all, the authors are confident that the benefits far outweigh the risks with SAINT, and they hope their work will pave the way towards new treatment options for many patients around the world.
A promising approach
"It works well, it works quickly and it's noninvasive," said Nolan Williams, MD, an assistant professor of psychiatry and behavioral sciences, and senior author of the study. "It could be a game changer."
The study included 29 participants with treatment-resistant depression. They ranged in age from 22 to 80, and had suffered from depression for an average of nine years at the time of the study. All of these cases have proven to be resistant to medication. Participants who were on medication during the study maintained their regular dosage, but those who weren't did not start any course during the treatment period.
They were split into two groups, one of which received the SAINT treatment, with the other receiving a placebo procedure that mimicked it. Five days into the treatment, 78.6% of the participants in the SAINT group no longer qualified for depression as judged using several evaluation efforts. The effects were sustained over time after the treatment had ceased, the authors note.
Current transcranial magnetic stimulation options that carry the approval of the Food and Drug Administration require six weeks of daily sessions, the authors explain. It's effective in about half the patients who undergo such treatments, and only about a third show remission from depression following the treatment.
SAINT builds on these approaches by first targeting the pulses in different areas tailored after each patient's neurocircuitry, and by delivering a greater number of magnetic pulses at a higher frequency.
In order to determine the particularities of each patient's dorsolateral prefrontal cortex -- an area of the brain involved in regulating executive functions --, the authors performed an MRI analysis on each participant before the start of the study. Their goal was to find the exact subregion in the brain that had the strongest functional link to the subgenual cingulate. This structure has been documented to exhibit heightened levels of activity in people experiencing depression. The goal of the magnetic stimulation treatment is to strengthen the link between the two areas in order to allow the dorsolateral prefrontal cortex to better control the activity in the subgenual cingulate.
The density of the pulses delivered in this trial was three times greater than that of currently-approved treatments: 1,800 per session compared to the regular number of 600. Finally, instead of providing one treatment session per day, the team gave their participants 10 10-minute treatments, with 50-minute breaks in between. The control group underwent 'treatment' with a magnetic coil that mimics the experience of the magnetic pulses.
Both groups wore noise-canceling earphones and received a topical ointment to dull sensation before each session.
Four weeks after the trial, 12 of the 14 participants in the experimental group showed improvements in their symptoms. According to FDA criteria for remission, 11 of them were officially cured of depression. In the control group, only 2 out of 15 patients met the criteria for remission.
The team is particularly interested in using SAINT to treat patients who are at a crisis point. Their study revealed that participants felt better and had attenuated symptoms within days of starting SAINT; this timeframe is much shorter than what is seen with medication, where improvements can take up to a month or more.
"We want to get this into emergency departments and psychiatric wards where we can treat people who are in a psychiatric emergency," Williams said. "The period right after hospitalization is when there's the highest risk of suicide."
The paper "Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial" has been published in the American Journal of Psychiatry.