Neuromodulation therapy may improve treatment-resistant depression

A high dose of intermittent theta-burst stimulation with functional-connectivity-guided targeting outperformed sham stimulation for treatment-resistant depression.

Researchers reported the results of the intervention, called Stanford Neuromodulation Therapy (SNT), in a double-blind randomized controlled trial published in American Journal of Psychiatry.

“Repetitive transcranial magnetic stimulation (rTMS) has been available for over a decade, but its full potential for altering brain function in a positive, non-invasive way had yet to be discovered,” co-author Nolan R. Williams, MD, of the department of psychiatry and behavioral sciences at Stanford University, told Healio Psychiatry. “The FDA had approved a 6-week treatment course for patients with treatment-resistant depression, but it had modest efficacy, with the minority of patients experiencing remission of symptoms in controlled trials. However, it was clear there was vast potential in the technology.”

Williams and colleagues sought to address the limitations of this prior research by developing SNT, formerly referred to as Stanford accelerated intelligent neuromodulation therapy (SAINT), which requires 5 days. In a prior study, researchers found that 90% of participants showed remission of symptoms, “a clear sign that SAINT had promise,” Williams said.

In the current sham-controlled double-blind trial of SNT, Williams and colleagues tested the intervention among participants with treatment-resistant depression with current moderate-to-severe depressive episodes. They randomly assigned participants to active (n = 14) or sham (n = 15) SNT and used resting-state functional MRI to individually target the region of the left dorsolateral prefrontal cortex with the strongest functional anticorrelation with the subgenual anterior cingulate cortex. Montgomery-Åsberg Depression Rating Scale (MADRS) 4 weeks after treatment served as the primary outcome.

Results showed a mean percent reduction from baseline in MADRS score 4 weeks after treatment of 52.5% in the active treatment group vs. 11.1% in the sham treatment group.

“There is an immediate need for a treatment like this in emergency situations,” Williams said. “As a society, we often treat mental health emergencies differently than other acute health issues. Part of that has to do with the lack of available treatments.”

Williams also noted that although additional studies are needed to replicate the findings of the current study, SNT may eventually be used in hospital settings to stabilize suicidal patients.

“Studies have shown the highest risk of suicide is actually in the weeks following a discharge,” Williams said. “With SNT, it’s possible that patients may be discharged after the 5-day treatment with improved mood and feeling safe.”