Wednesday, April 24th, 2013
Overview: The standard of care for clinical depression has significant limitations: traditional drugs that focus on monoamine neurotransmitters can take several weeks to be effective, and many patients never respond to any form of treatment. Several clinical trials have demonstrated strikingly better outcomes using the anesthetic ketamine to treat depression. Notably, a single application can have rapid and lasting antidepressant effects in patients who do not respond to other treatments. Because ketamine is an antagonist of NMDA-type glutamate receptors, research is focused on the role of glutamate neurotransmission in depression and on drug development that targets the glutamatergic system. The March 25, 2013, meeting of the Academy’s Biochemical Pharmacology Discussion Group, Treatment-resistant Depression: Glutamate, Stress Hormones, and their Role in the Regeneration of Neurons, presented this new research and the avenues it is opening for the treatment of depression.
Tags: antidepressants, Anxiety, depression, depression treatment, major depression, MDD, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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Thursday, March 21st, 2013
Published 18 March, 2013 WBUR’s Here & Now
Researchers, in preliminary research, have found Botox might bring relief to patients suffering from depression or anger issues. Though Botox is typically used cosmetically and for a number of health issues, some hope this means it could be used for mental health reasons in the future.
The emotions we show on our face often mirror the emotion we feel internally. But for people suffering from depression, the emotions shown externally can potentially overpower emotions felt internally.
Dermatologist surgeon Dr. Eric Finzi discovered that, in some patients, injecting Botox into the muscle that normally contracts when a patient frowns helped to relieve depression.
Finzi’s mother battled with depression intermittently throughout her life, and often showed a furrowed brow.
When his mother died, Finzi said he was motivated to find a connection between her facial expressions and a role they might have played in her depression.
Thursday, March 21st, 2013
By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 13, 2013
Those with schizophrenia are often functionally limited by mental or cognitive impairments.
Memory, attention, IQ, and verbal and motor skills are often disrupted, and these deficits tend to compromise the ability to perform normal day-to-day activities.
Scientists have been exploring a variety of strategies to reduce these impairments, including “exercising the brain” with specially designed computer games and medications that might improve the function of brain circuits.
In a new study, Mera Barr, Ph.D., and her colleagues at University of Toronto provide evidence that stimulating the brain using repetitive transcranial magnetic stimulation (rTMS) may be an effective strategy to improve cognitive function.
“In a randomized controlled trial, we evaluated whether rTMS can improve working memory in schizophrenia,” said Barr and senior author Zafiris Daskalakis, M.D.
“Our results showed that rTMS resulted in a significant improvement in working memory performance relative to baseline.”
Transcranial magnetic stimulation is a non-invasive procedure that uses magnetic fields to stimulate nerve cells. It does not require sedation or anesthesia and so patients remain awake, reclined in a chair, while treatment is administered through coils placed near the forehead.
In 2008, rTMS was FDA-approved to treat depression for individuals who don’t respond to pharmacotherapy.
The study is presented in the journal Biological Psychiatry.
“TMS can have lasting effects on brain circuit function because this approach not only changes the activity of the circuit that is being stimulated, but it also may change the plasticity of that circuit, i.e., the capacity of the circuit to remodel itself functionally and structurally to support cognitive functions,” said Dr. John Krystal, editor of the journal.
Experts say that previous studies have shown that rTMS improves working memory in healthy individuals, and a recent open-label trial showed promising findings for verbal memory in schizophrenia patients.
These findings informed the current study to determine if high frequency rTMS could improve memory in individuals with schizophrenia.
Researchers recruited medicated schizophrenia patients who completed a working memory task before and after 4 weeks of treatment.
Research methodology involved a double-blind study, where neither the patients nor the researchers knew who was receiving real rTMS or a sham treatment that was designed to entirely mimic the procedure without actually delivering brain stimulation.
Investigators discovered TMS not only improved working memory in patients after 4 weeks, but the improvement was to a level comparable to healthy subjects.
These findings suggest that rTMS may be a novel, efficacious, and safe treatment for working memory deficits in schizophrenia.
While the current findings are preliminary, researchers hope additional investigations will replicate the findings and provide an approved treatment for cognitive impairments in schizophrenia.
The authors concluded: “Working memory is an important predictor of functional outcome. Developing novel treatments aimed at improving these deficits may ultimately translate into meaningful changes in the lives of patients suffering from this debilitating disorder.”
Tags: Anxiety, dementia, depression, major depression, memories, memory, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
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Thursday, March 21st, 2013
Harborough Mail- Published on 04/03/2010 16:48
A handheld device could ‘zap away’ headaches according to several newspapers. They say that the device, which delivers a magnetic pulse to the back of the head, could be an alternative to drug treatments for sufferers.
The news is based on a well-conducted randomised controlled trial and has found promising results when using a ‘single-pulse transcranial magnetic stimulation’ device to treat people who frequently suffer from migraine with visual distortions (aura). Within two hours of the onset of symptoms more people were pain-free when using the handheld device than those who had used an identical dummy device.
Although the study has reliable results, there are some points to consider when putting these findings into context. Importantly, the results will need to be verified in larger trials that directly compare the technology to other active treatments for migraine, principally medication. Therefore, the news reports are premature in announcing this treatment as an ‘alternative’ to pain medications. Further issues of optimal use, effectiveness and safety also need to be explored when further researching this promising technology.
Where did the story come from?
This research was conducted by Dr Richard Lipton and colleagues from Einstein College of Medicine, New York and other institutions across the US. The study was funded by Neuralieve, the medical technology company that makes the prototype device being tested. The study was published in the peer-reviewed medical journal The Lancet.
What kind of research was this?
This was a phase 2 randomised, ‘sham’-controlled trial testing the use of a prototype ‘single-pulse transcranial magnetic stimulation’ (sTMS) device using magnetic fields to treat certain types of migraine. The study was termed a ‘sham trial’ as it compared a real device against an identical mock device that actually performed no function.
A randomised controlled trial is the best way of examining the safety and efficacy of a treatment. However, results of this trial will need follow-up in larger phase 3 trials that compare sTMS use to other active treatments for migraine (eg replace the sham sTMS device with suitable drugs) and in larger groups of people.
News coverage has generally reflected the findings of this well-conducted trial, although most reports have jumped too far ahead in hailing this as a new treatment for migraine ‘at the press of a button’. The current stage of this research, plus the fact that it hasn’t been compared to any active treatment, mean that questions still remain over its safety and efficacy.
What did the research involve?
This research was carried out at 18 different locations across the US and studied people who experienced migraines accompanied by aura – visual distortions that precede the pain of migraines. Aura symptoms usually last less than an hour and can include visual disturbances (such as flashing/flickering spots of lights, zigzag lines or even temporary blindness), numbness, tingling sensations and slurred speech.
All eligible adults met diagnostic criteria of having at least 30% of their migraines accompanied by aura. Their migraines also had to occur at least once a month and to be associated with moderate or severe headache in 90% of those attacks. People were excluded if their migraine was suspected to be caused by, or associated with, overuse of painkillers, use of other medications, or underlying disease or trauma.
Before the treatment phase began, the recruited participants were trained in the use of an electronic headache diary, which they used for one month to verify that they had a suitable diagnosis of migraine for the trial. Sixty-six people dropped out in this phase, after which the remaining 201 individuals were randomly allocated by computer to either sham stimulation (99 people) or sTMS (102 people). Training was given in the use of the devices before the trail.
The sTMS machine tested was a handheld device that could be positioned against bone at the base of the skull. It delivers two magnetic pulses, 30 seconds apart, when the ‘treat’ button is pressed. The ‘sham’ stimulator device was identical to the real device, even buzzing and vibrating in the same manner. Neither researchers nor participants knew which device each person was using.
Participants were instructed to treat up to three attacks over a three-month period at the onset of aura. The main outcome was being pain-free within two hours of the attack, and with secondary outcomes being no difference between the sTMS device and sham device in terms of reports of symptoms of nausea, oversensitivity to light, and oversensitivity to sound within two hours of the attack. All participants were allowed to use their usual migraine medication throughout the trial.
What were the basic results?
The researchers excluded the results on 37 people who did not treat a single migraine attack during the trial. This left 164 patients (82 sTMS and 82 sham). Significantly more people treated with sTMS were pain-free within two hours (39% v 22%; 17% difference, 95% CI 3 to 31%).
At 24 and 48 hours after using the device, sustained pain-free response rates were also better in the treatment group.
There were also no differences between the sTMS and sham groups in rates of associated nausea, sensitivity to light, or sensitivity to sound. No device-related serious adverse effects were observed.
How did the researchers interpret the results?
The researchers conclude that early treatment of migraine with aura using sTMS resulted in increased freedom from pain at two hours compared with sham stimulation, and sustained absence of pain at 24 and 48 hours. They say that sTMS this could be a promising new treatment for migraine with aura.
This well-conducted, double-blind, randomised controlled trial has found promising results when using single-pulse transcranial magnetic stimulation (sTMS) to treat people who frequently suffer from migraine with visual aura. Within two hours of the onset of symptoms, more people were pain-free when using the handheld device than those who had used an identical ‘sham’ device.
Although the study has reliable results, there are a couple of things to consider when putting these findings into context:
This was a phase 2 trial, which has so far compared sTMS only with no treatment in a relatively small number of people (164 completed the study). Results will need follow-up in larger phase 3 trials that compare sTMS to other active treatments for migraine (eg actual drugs rather than sham sTMS) and in larger groups of people.
People in this trial were allowed to use medications to treat their migraine as normal, so at this stage it is difficult to extract the extent of the effect that sTMS alone is having, for example how people would feel if they used sTMS as their sole treatment for migraine. Therefore, the news reports are premature in announcing this treatment as an ‘alternative to pain medications’.
Although no significant adverse effects of this device were observed, a greater number of people who had used this device for much longer than three months (the period of this study) would need to be observed in order to see whether there were any longer-term adverse effects or health risks of sTMS.
As the researchers say, they have not yet explored the possible range of sTMS doses that could be given, or the optimum timing of treatment (at what stage in the headache, for example). The device at the current time would only be suitable for people who experience migraine with visual aura.
Overall, the findings of this study are promising, and further trials are awaited.
Tuesday, February 5th, 2013
Dr. Sapna Parikh NEW YORK (WABC) – Imagine finding a new, life changing use for a dangerous street drug, one that has been known for destroying lives. Now, an experimental treatment could hold life changing promises.
What’s exciting about this drug is that it works fast. Most anti-depressants that we use now take about a month to kick in. But the studies so far show this one starts to work the very same day.
You may know it as the club drug, Special K, but now researchers say ketamine is a promising new treatment option for depression.
About half the patients get about 50% better with one dose of ketamine,” said Dr. John Mann with NYS Psychiatric Institute.
And that one dose works in just a few hours. Ketamine targets a chemical in the brain called glutamate and unlike most antidepressants which target serotonin. Dr. John Mann is overseeing three ketamine studies at the Columbia Psychiatric Institute.
“This may be a medication that works faster and 2 it may work in some patients who have not had much success in getting better with regular treatments,” he adds.
Todd Landua is one of those patients, he’s battled depression for 4 years.
“Basically I felt fear, sadness or nothing- that was it,” he said.
He took part in the new clinical trial, and says after he got ketamine, he felt an immediate difference.
“I was recovering memories that had been very painful for me but the pain was completely gone,” adds Todd.
But although it’s fast acting, it’s not necessarily long lasting. So far they found the benefits of one dose last about a week.
That could mean needing frequent IV infusions of ketamine, until there’s a better way like a pill. And in large doses, ketamine can cause dangerous symptoms of psychosis, but Dr. Mann says they are working to find the lowest dose possible that works, but with the fewest side effects.
The studies at Columbia are scheduled to go until 2017.
Thursday, January 17th, 2013
Samuel Pepys was a member of parliament and a high-ranking figure in the Admiralty, where he was instrumental in strengthening the Royal Navy, but he is best remembered as a diarist. His account of the Great Fire of London, which razed the area where the city – the financial nexus of the United Kingdom – now stands, is perhaps the definitive eyewitness narrative of the tragedy. Fully six months after Pepys saw the Great Fire devour people and buildings, his sleep was broken by nightmares of the horror.
Today we would say that Pepys was probably suffering from post-traumatic stress disorder (PTSD), the mental state that we associate with the broken military dribbling back from 12 years of war in the Middle East.
PTSD denotes a psychiatric illness that follows a physical or psychological trauma, like seeing your buddy’s legs blown of by a roadside bomb. But PTSD is older even than warfare; it is probably as old as anxiety itself. However, wars have been a propitious time for studying PTSD, not least because physicians encounter so many more cases of it.
The term PTSD entered the official lexicon of psychiatric diseases in the 1980 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) and underwent revision in the subsequent edition of the manual; today, clinical psychiatrists, many researchers, disability evaluators, the courts and, for better or worse, anyone else who requires a standardized set of criteria, rely on DSM-IV.
Like other diseases, psychiatric illnesses are recognized by their symptoms, and the clusters of symptoms define a syndrome. PTSD has three important symptoms:
1.hyper-arousal – a state of persistent mental and physical excitation that may endure for months or years;
2.avoidance and numbing – psychological defense mechanisms to block out memories of the trauma, or even life situations that resemble the trauma;
3.re-experiencing the trauma in nightmares like Pepys’, or experiencing “flashbacks,” defined as vivid, waking remembrances of the traumatic event.
In its current incarnation, DSM classifies PTSD as an anxiety disorder, along with free-floating anxiety and panic disorder. One skeptic among many with respect to this classification is co-author James L. Knoll IV MD, associate professor of psychiatry and director of the division of forensic psychiatry at the State University of New York Upstate Medical University in Syracuse. Knoll contends there is strong overlap with other anxiety disorders, but with PTSD, there is very likely a different biological mechanism going on. As a forensic psychiatrist, Knoll is no stranger to PTSD, for he works with crime victims who may have been traumatized for protracted periods of time, if not for life.
Almost every major war in modern times has been accompanied by a different synonym for PTSD, each perhaps with a unique tweak. The first scientifically rigorous investigations of this condition were carried out by Civil War military surgeon J.M. Da Costa. Though the label “Da Costa’s Syndrome” is still used in medical histories, Da Costa himself chose the term “irritable heart” because of the severe, frightening pounding of the heart that prevented soldiers from taking to the field. And the treatment for irritable heart? The only sedative-hypnotic of the day: rum.
In the serene Victorian years that followed the Civil War, ladies of means took to their beds with symptoms of palpitations, shortness of breath, tremulousness and perspiration. Their physicians gave them the diagnosis of neurasthenia, a misleading expression which means “nervous exhaustion.” These women – and many men of the day – had most if not all of the symptoms of Da Costa’s Syndrome. By today’s diagnostic criteria, men and women previously designated as suffering from “neurasthenia” would meet the criteria for PTSD.
With the onset of World War I, British military physicians (and their counterparts in the German trenches) soon observed a cluster of symptoms that they attributed to a kind of concussion from the explosion of artillery shells. The condition was dubbed “shell shock,” but when these soldiers were examined more closely, 60-80 percent were deemed “neurasthenic” and 10 percent suffered from what was then called “a fugue state” and which we now recognize as numbing.
And so it went from war to war. Da Costa’s Syndrome became whatever psychiatric or physiological symptom seemed the most prominent: effort syndrome, neurocirculatory asthenia, combat fatigue, post-Vietnam Syndrome, and finally PTSD. As new drugs became available, physicians tried them, graduating from alcohol to laudanum (a tincture of opium) to chloral hydrate and barbiturates to benzodiazepines and Thorazine-like compounds to antidepressants.
Just as DaCosta’s Syndrome, effort syndrome, neurasthenia and PTSD have a common profile on the symptomatic level, so too do they have a common denominator on the physiological level. This was first shown by two British investigators in 1946 (M. Jones and V. Mellersh, Psychosomatics). The scientists were studying the “effort syndrome.” When these patients are exercised, it turns out that their blood lactate, a normal product of muscular exertion, is significantly higher than controls without the effort syndrome. This finding, which still has psychiatrists scratching their heads, was confirmed by several other investigators in the next few years.
There the matter lay until 1967, when two Washington University psychiatrists conducted an ingenious experiment: they infused lactate into an arm vein of normal controls and patients suffering from chronic anxiety. The lactate had no effect on controls, but the patients with anxiety “neurosis” (to use a term that was prevalent at the time) experienced full-blown panic attacks from the lactate infusion; in some instances the reaction was so violent that the infusion had to be stopped prematurely.
So, exercise abnormally raises the level of blood lactate in patients with “effort syndrome,” while conversely, infusion of lactate into patients with a history of anxiety provokes panic attacks. Research with lactate continues; of particular interest is that several teams (i.e., Am J Psychiat 1987 Oct;1317-9) have administered lactate infusions to patients with PTSD; the infusions were found to provoke flashbacks of the traumatic event.
The word “panicogenic” was coined for a diverse group of chemicals that trigger panic attacks. Besides lactate, they include carbon dioxide and cholecystokinin. It’s not known whether these chemicals are impacting on the physiological substrate of anxiety, or whether their effects are parenthetical. Evidence from the science of pharmacology suggests that they really do mobilize the physiological mechanism of anxiety. The reasoning goes like this: it’s not known whether the diverse panicogens all act on the same underlying, natural cause or causes of anxiety. As we’ll see, drugs that block anxiety attacks (namely antidepressants) also block the action of panicogens, suggesting that panicogens hit on the underlying cause of anxiety, but this is only an educated guess.
It is well established that most antidepressants block panic attacks, but they do not work like the benzodiazepines (Klonopin, Valium, Xanax, other peer drugs). Antidepressants usually take at least two weeks to kick in, because this is thought to be the time required to boost neurotransmission of serotonin in the brain. On the other hand, benzodiazepines often calm the patient in a couple of hours by inhibiting the central nervous system through their effect on releasing the neurotransmitter GABA (gamma-amino-butyric -acid). Anti-depressants prevent the attacks from “happening.” One such antidepressant is the drug imipramine (Tofranil). It has been shown that imipramine blocks the panic attacks artificially induced by panicogens, just as it blocks “natural” panic attacks.
It is especially interesting, therefore, that antidepressants constitute front-line therapy for patients with PTSD. These days, psychiatrists generally use specific serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac or Paxil, or a specific serotonin/noradrenaline reuptake inhibitor, notably the drug Effexor. To these, in his clinical practice, co-author Knoll may add low doses of a second generation antipsychotic, of which the most familiar are Abilify, Seroquel or Zyprexa. Antipsychotics are not curative in themselves, but they enhance the effectiveness of antidepressants. A third drug in Knoll’s armamentarium is Prazosin. Though marketed as an antihypertensive, practitioners and patients have found Prazosin effective at blocking nightmares. Of particular interest is a study by Michael H. Mithoefer, MD that MDMA (a k a ecstasy) was found to be highly effective for treating PTSD in combination with psychotherapy. And at the University of Arizona, Sue Sisley MD, a psychiatrist and internist, is awaiting delivery of a supply of marijuana from the National Institute on Drug Abuse (NIDA) to begin a trial approved by the Food and Drug Administration (FDA). There has been some interest in propranolol (Inderal) for “erasing” PTSD-type memories, but this is based on anecdotal accounts and small-scale studies. On the other hand, propranolol can cause vivid nightmares – the last thing you’d want in a patient with PTSD.
Besides drugs, psychiatrists are studying other approaches to treating PTSD. Thus, retired Lt. Gen. Stephen N. Xenakis MD is using hyperbaric oxygen therapy. In this procedure, the patient breathes in oxygen at very high pressure. This ties in neatly with what we know about lactate; high levels of oxygen would be predicted to speed up cellular metabolism, burning off lactate in the process.
A second approach for which there are a number of positive claims is transcranial magnetic stimulation (TMS). Briefly, TMS uses an oscillating magnetic field to release neurotransmitters over the course of a month of daily outpatient treatments; it bears no resemblance whatever to shock therapy. We were informed by the manufacturer of the NeuroStar TMS instrument that the military is interested in TMS and has purchased a number of instruments.
Thursday, January 17th, 2013
By Helen Albert, Senior medwireNews Reporter-A month of daily transcranial magnetic stimulation targeting the supplemental motor area (SMA) results in lasting improvements in symptoms of Tourette syndrome, show study findings.
“Repetitive transcranial magnetic stimulation (rTMS)… involves repetitive generation of a brief, powerful magnetic field by a small coil positioned over the scalp that induces an electric current in the brain,” explain Nong Xiao (Chongqing Medical University, Yuzhong district, China) and colleagues.
The technique is designed as a noninvasive treatment for a range of neurological and psychiatric disorders including migraine, stroke, and Parkinson’s disease.
In this study, the researchers tested the capacity of low-frequency 1 Hz rTMS applied at 20 daily sessions (Monday-Friday) over 4 weeks for treatment of the motor and speech neurological tics displayed by patients with Tourette syndrome, on the basis that low-frequency rTMS (≤1 Hz) inhibits and high-frequency rTMS (>5 Hz) promotes cortical excitability.
In total, 25 children under 16 years took part in the study. After 4 weeks of treatment, the team observed no improvements in tic symptoms in six children, but significant improvements in these symptoms that lasted until 3 months in 19 children, and until 6 months in 17 children (68%).
On average, significant reductions were seen in the scores obtained on various tests by the children at 4 weeks compared with baseline. These included the Yale Global Tic Severity Scale; Clinical Global Impression Scale; Swanson, Nolan and Pelham Rating Scale, version IV for attention-deficit hyperactivity disorder (SNAP-IV); Children’s Depression Inventory; Spence Children’s Anxiety Scale; and a novel Attention Test.
Overall scores for all these tests were lower at 6 months than at baseline, but only the SNAP-IV and Attention test scores were significantly lower at 6 months than at 4 weeks.
“Low-frequency (1 Hz) rTMS to the SMA significantly improved Tourette syndrome symptoms, suggesting that it is effective on tics, hyperactivity, attention deficit, depression and anxiety in children with Tourette syndrome,” write Xiao and co-workers in the Journal of Clinical Neuroscience.
“These collective results suggest the need for further studies using rTMS as a research and clinical therapeutic tool in psychiatric and neurological diseases, with particular attention to patients with Tourette syndrome.”
Wednesday, October 17th, 2012
PHILADELPHIA, Oct. 16, 2012 /PRNewswire via COMTEX/ — Neuronetics, Inc., a privately-held medical device company committed to the development of innovative, non-invasive therapies to treat psychiatric conditions, announced today that its NeuroStar TMS Therapy® System has been awarded the prestigious Phoenix 2012 Most Promising New Product Award at the 19th annual Phoenix Conference. Phoenix, the Medical Device and Diagnostic Conference for Chief Executive Officers, presents awards each year to exceptional individuals and companies representing the medical device and diagnostic industry.
The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy System is a non-invasive, non-drug therapeutic device that delivers magnetic resonance imaging (MRI)-strength, pulsed magnetic fields to stimulate nerve cells in the part of the brain thought to control mood. The NeuroStar TMS Therapy® System is the first and only TMS system cleared by the US FDA for major depressive disorder (MDD). It has been proven to be safe and effective for patients with MDD who have not benefitted from antidepressant medication. The goal of NeuroStar TMS Therapy is remission from depression without the side effects typical of antidepressant medications.
“On behalf of the entire team at Neuronetics, I am honored to receive the Phoenix 2012 Most Promising New Product Award for NeuroStar TMS, a breakthrough in depression treatment, and appreciative that the industry has recognized its value to patients and physicians,” said Bruce Shook, President and CEO, Neuronetics, Inc. “We are privileged to offer a proven treatment to the millions of people suffering with major depressive disorder and contribute toward their wellness.”
Depression is a serious illness that affects about 20 million Americans annually. People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiousness, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems. It is estimated that about four million patients do not benefit from standard treatments for depression, even after repeated treatment attempts.
About NeuroStar TMS Therapy®
Neuronetics’ NeuroStar TMS Therapy System was cleared by the FDA in October 2008 for the treatment of Major Depressive Disorder (MDD). NeuroStar TMS Therapy is indicated for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly-focused MRI-strength magnetic field pulses. The treatment is available by prescription and typically administered daily for 4-6 weeks.
Wednesday, September 26th, 2012
CALGARY — Calgary researchers are studying a new way of helping teenagers cope with depression by using magnetic fields to give a “booster shot” to the part of the brain used to make decisions.
Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique used extensively to treat adults, will now be used on youth as part of a project at the Alberta Children’s Hospital Research Institute for Child and Maternal Health.
The Calgary hospital is equipped with the only brain stimulation lab of its kind with the ability to perform the treatment on teenagers, said principal investigator Dr. Frank MacMaster, who is working with pediatric neurologist Dr. Adam Kirton on the pilot study.
The project, funded by community donations, is geared toward teenagers with depression who haven’t responded well to standard treatments, including medication and psychotherapy, MacMaster said.
The researchers will use transcranial magnetic stimulation to excite the frontal lobe — “the boss of the brain” — to help regulate their emotions, MacMaster said.
It will give a “booster to that part of the brain to try to help it do its job better so these kids can fight the symptoms.”
The goal of medication and cognitive behavioural therapy is to change the brain so the patients feel better, and TMS is no different, MacMaster said. It could provide a new treatment option for the approximately 50 per cent of young people with depression whose symptoms aren’t helped by the current therapies, he added.
The researchers are looking for 50 patients between 12 and 21 years old, who have treatment-resistant depression, to participate in the study.
Thursday, September 20th, 2012
The therapy, transcranial magnetic stimulation (TMS), sends short pulses of magnetic fields to the brain. TMS has been approved since 2009 for patients who have major depression and have failed at least one antidepressant.
The Loyola study will include patients who suffer from both depression and tinnitus. Recent studies have found that about 12 percent of people with chronic tinnitus also suffer depression and anxiety—a rate three times higher than that of the general population.
Tinnitus is the perception of sound in one or both ears when there is no external source. It can include ringing, hissing, roaring, whistling, chirping or clicking. About 50 million Americans have at least some tinnitus; 16 million seek medical attention and about 2 million are seriously debilitated, according to the American Tinnitus Association. There is no cure. The perception of phantom sounds can be more pronounced in people who are depressed. Moreover, antidepressant medications can cause tinnitus occasionally, said Dr. Murali Rao, principal investigator of Loyola’s TMS tinnitus study.
Several earlier studies have found that TMS can benefit tinnitus patients. Loyola’s study is the first to examine patients who suffer from both tinnitus and depression. “The combination of these two conditions can be extremely debilitating,” Rao said.
During TMS treatment, the patient reclines in a comfortable padded chair. A magnetic coil, placed next to the left side of the head, sends short pulses of magnetic fields to the surface of the brain. This produces currents that stimulate brain cells. The currents, in turn, affect mood-regulatory circuits deeper in the brain. The resulting changes in the brain appear to be beneficial to patients who suffer depression. Each treatment lasts 35 to 40 minutes.
The study will enroll 10 to 15 patients. Each patient will receive five treatments a week for four to six weeks, for a total of 20 to 30 treatments. Each patient will be evaluated by a physician three times during the treatment course, or more frequently if the doctor deems necessary. The treatments do not require anesthesia or sedation. Afterward, a patient can immediately resume normal activities, including driving. Studies have found that patients do not experience memory loss or seizures. Side effects include mild headache or tingling in the scalp, which can be treated with Tylenol.