summary: The major clinical trial BRIGhTMIND found that MRI-guided transcranial magnetic stimulation (TMS) significantly reduced symptoms of severe depression for at least 6 months.
The study, which involved five sites across the UK, represents a significant improvement over previous TMS treatments, where improvements lasted only one to three months. This study demonstrated that precisely targeting brain regions using MRI neuronavigation in TMS treatment led to sustained improvements in depression, anxiety, and cognitive function.
This research is particularly impactful for patients with treatment-resistant depression (TRD), who may be able to expect longer-term symptom relief with perhaps one or two annual treatment courses.
Important facts:
- MRI-guided TMS significantly improved depression and anxiety symptoms for up to 6 months.
- More than two-thirds of participants responded to treatment, with a third showing 50% improvement and a fifth achieving sustained remission.
- The success of this study has led to three NHS Mental Health Trusts offering TMS services for treatment-resistant depression.
sauce: University of Nottingham
A major clinical trial shows that using MRI and tracking to induce magnetic stimulation into the brains of people with severe depression may reduce symptoms for at least six months and significantly improve quality of life. It is shown that there is.
The results of the test are natural medicine, Participants who used MRI Neuronavigated Transcranial Magnetic Simulation (TMS) showed significant improvements in depression, anxiety, and thinking severity, and improved function and quality of life over an average of 26 weeks. got it. This was a significant increase from previously reported improvements that lasted only 1-3 months for him.
The BRIGhTMIND randomized controlled trial was led by experts at the University of Nottingham, hosted by Nottinghamshire Healthcare NHS Foundation Trust, and funded by a partnership between the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). Ta. Five centers across England took part: Nottingham, Camden, Islington, Newcastle, Northampton and Oldham.
Transcranial magnetic simulation (TMS)
TMS is an outpatient treatment that sends powerful magnetic pulses to the left side of the head, just above the temporal region of the scalp. The patient is conscious and undergoes 20 sessions over 4 to 6 weeks.
This method has been used to treat patients with severe depression since the 1980s, but targeting the precise areas of the brain where stimulation is thought to be effective could make the treatment's effects last longer. Evidence was obtained.
Major depression is the leading cause of disability-years lost worldwide (WHO, 2017), and depression-related suicide is the biggest killer of people aged 15-49.
Antidepressants and therapies offered as first- or second-line treatments help two-thirds of people with depression, but the remaining one-third have treatment-resistant depression (TRD). I am. This is defined as a lack of response to two courses of antidepressants.
The purpose of this study was to determine whether the effects of TMS use could be extended for at least 6 months. This means that her TRD patients who respond to treatment may only need one or two courses of treatment per year to be relatively sustainable. I am healthy and have no symptoms of depression.
neuronavigation
This trial is the first of its kind in the world to examine outcomes after 6 months, and it is possible that this could be achieved by using functional MRI with TMS to define the precise areas of the brain to be irradiated. It suggests something. His MRI is not typically used for this treatment.
The research team used neuronavigation. Neuronavigation is a computerized tracking system that uses light to deliver TMS and is a way to pinpoint the area of stimulation so that the same area is targeted in all 20 treatment sessions.
Richard Morris, professor of psychiatry at the School of Medicine and director of the Center for Mood Disorders at the Institute of Mental Health at the University of Nottingham, said: location, but this rarely happens.
“With this method, the stimulation points are measured by shining light through both earlobes and the tip of the nose from the first treatment. With MRI, the stimulation points are set individually, and with neuronavigation, the same points are stimulated in each treatment session. And confirm that it has.
“This reduces the variability in stimulation from session to session. Because the magnetic pulses can be focused, there are usually only mild short-term side effects, and you can return to your daily routine as soon as you return from the hospital. can.”
A total of 255 participants participated in the trial, all of whom completed 20 TMS sessions. Patients already receiving specialist mental health services were recruited and both primary care trusts and general practitioners were approached, with all participants requiring a referral from their GP to participate.
Significant improvement in quality of life
More than two-thirds of participants responded to treatment, one-third showed a 50% improvement in symptoms, and five managed to enter and remain in remission.
“Given that these patients have not responded to the previous two treatments and have had the disease for an average of seven years, we have seen such a remarkable response rate, with a fifth patient showing a sustained response.” That's really encouraging,” Professor Morris said.
He added: “Patients who responded to treatment were able to stay in relatively better shape than before with just one or two treatments a year. The changes were significant enough to not only reduce symptoms of the disease, but improve concentration, memory, anxiety, and subsequent quality of life.
“These results have already persuaded three NHS mental health trusts, including Nottinghamshire Healthcare NHS Foundation Trust, to regularly offer the new TMS service for treatment-resistant depression.”
One participant in this study said: “It has been a pleasure working with the research and clinical teams and I feel that I am making an important contribution to such groundbreaking research from the patient perspective. Our goal is to make stimulation a standard and universally available treatment option for hard-to-treat depression.”
Professor Danny McCauley, Scientific Director of the NIHR Programme, said: “High quality research funded by the NIHR and MRC is making a huge difference in improving health and care services.” It is great to see that three UK mental health trusts are now offering TMS to their patients on a regular basis, following the strong evidence from this study.
“These are important findings that show that this new technology has the potential to significantly benefit patients with severe depression who have failed other treatments.”
About this depression and neurotechnology research news
author: charlotte encombe
sauce: University of Nottingham
contact: Charlotte Anscombe – University of Nottingham
image: Image credited to Neuroscience News
Original research: Open access.
“A comparison of connection-induced intermittent theta bursts and repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial.Written by Richard Morris et al. natural medicine
abstract
A comparison of connection-induced intermittent theta bursts and repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial.
Disrupted interconnections between the right anterior insular cortex and the left dorsolateral prefrontal cortex are associated with depression and may be a target for neuromodulation.
In a 5-center, parallel, double-blind, randomized controlled trial, resting-state functional magnetic resonance imaging neuroguided connectivity-guided intermittent theta burst stimulation (cgiTBS) was tested based on effective connectivity from the right anterior insula to the left anterior insula. Customized for each. Dorsolateral prefrontal cortex.
We evaluated its effectiveness in reducing depressive symptoms, the primary outcome measured by the 17-item GRID Hamilton Depression Rating Scale, using in-hospital structural magnetic resonance imaging over 8, 16, and 26 weeks. Neuronavigation (MRI) was tested in comparison to repetitive transcranial magnetic stimulation (rTMS). Standard stimulation site (F3) for patients with “treatment-resistant depression.” P
Participants received cgiTBS (n= 128) or rTMS (n= 127) Resting state functional MRI at baseline and 16 weeks. Sustained reductions in depressive symptoms were seen over 26 weeks, with the primary outcome GRID Hamilton Depression Rating Scale 17-item score (intention-to-treat adjusted mean, -0.31, 95% confidence interval (CI) -1.87) between groups. There was no difference. ,1.24, P= 0.689).
Two serious adverse events may be related to TMS (mania and psychosis). MRI neuronavigated cgiTBS and rTMS were similarly effective in patients with treatment-resistant depression over 26 weeks (trial registration number ISRCTN19674644).
