Repetitive transcranial magnetic stimulation, a non-invasive brain stimulation technique, may be an effective and well-tolerated treatment for major depressive disorder with a seasonal pattern, according to a new study. . This finding holds great promise for expanding treatment options for people suffering from seasonal depression, especially in areas where sunlight is limited during the winter. This research psychiatric research.
Major depressive disorder, a common mental illness, affects millions of people worldwide. Notably, a significant proportion of people with depression experience a seasonal pattern, with symptoms often worsening during the winter months when the days are shorter and darker. This study was driven by the need to understand whether rTMS, an established treatment for MDD, is equally effective for people who experience seasonal fluctuations in their depressive symptoms.
Repetitive transcranial magnetic stimulation (rTMS) is a type of brain stimulation therapy used to treat depression and other disorders. This involves placing a magnetic coil near the scalp and sending magnetic pulses to stimulate specific areas of the brain. This non-invasive method is increasingly being recognized as having the potential to alleviate symptoms of depression, especially when traditional treatments such as medication have been ineffective.
“Like most research in science, this study is based on observations that we decided to systematically study,” the study authors explained. peter jacobAssociate Scientist Sunnybrook Health Sciences Center In Toronto. “Living in Canada, the hours of daylight seem very short from November to March.”
“In Canada, like other countries with northern climates, the incidence of seasonal affective disorder is higher during this time of year compared to countries closer to the equator. will be shorter, resulting in an opposite seasonal pattern.”
“Many of our patients report feeling worse in late fall and winter. It is characterized by seasonal changes,” Jacob said. “Many of our patients felt that rTMS treatment helped minimize or prevent seasonal affective depression; has not been confirmed.”
“Additionally, we have noticed an increase in requests for additional rTMS treatments in recent months for patients who were successfully treated with rTMS earlier this year. We hope to study whether rTMS, which has been approved as a treatment for depressive disorders but has not yet been studied in seasonal affective disorder, may indeed be an effective option for patients with seasonal depression.”
“We are pleased that this is indeed the case, expanding the number of viable treatment options for this group of people and encouraging clinicians to listen to the 'signals' coming from their patients and systematically conduct follow-up studies.” “It suggested that it was important to do research on them,” Jacob said.
Researchers conducted a retrospective analysis of 127 patients who received their first rTMS treatment at Harquail Center. These patients were 16 years of age or older and diagnosed with major depressive disorder. To assess the severity of depression and the presence of seasonal patterns, her two important tools are the Hamilton Depression Rating Scale (HAMD-17) and the Personal Inventory of Depression and Seasonal Affective Disorder (PIDS). It was used.
Approximately 46% of participants identified a seasonal pattern to their depression. This high prevalence emphasizes the importance of exploring effective treatments for this subgroup.
The patients received high-frequency rTMS for four to six weeks, targeting the left dorsolateral prefrontal cortex, an area of the brain associated with mood regulation. “rTMS is a treatment that is typically performed five days a week for four to six weeks, for a total of 20 to 30 sessions. Each treatment session takes him 3 to 20 minutes depending on the protocol chosen,” Giacobbe explains. Did.
Treatment effectiveness was assessed through improvements in HAMD-17 scores and changes in self-reported depressive symptoms using the Quick Inventory of Depressive Symptomalogy (QIDS).
Researchers found that rTMS led to significant improvement in symptoms of depression, regardless of whether the patient exhibited a seasonal pattern. Notably, approximately 32% of patients achieved remission and 55% had a positive response to treatment, showing that their HAMD-17 scores decreased by more than 50% of their time.
Interestingly, this study found that higher scores on the Personal Inventory of Depression and Seasonal Affective Disorder were associated with greater improvement in depressive symptoms when rTMS treatment was initiated between September and February. It also turns out that they are related. Furthermore, the study showed that typical and atypical neurotrophic symptoms, such as changes in sleep patterns and appetite, improved similarly during the treatment period, regardless of season.
“When it comes to evidence-based options for treating seasonal depression, both phototherapy and SSRI drugs have been shown to be effective, but in our hospital, brain stimulation techniques such as rTMS “Many people seeking treatment do not respond to these treatments or are looking for alternatives to help them,” Giacobbe told PsyPost. “This study is the first of its kind to suggest that brain stimulation techniques such as rTMS may be an effective and well-tolerated treatment option for patients with seasonal depression.”
“The results of this study may expand the number of treatment options available for this group, particularly those who cannot tolerate or have not responded to either phototherapy or SSRI drugs. rTMS treatment is time-limited Given its nature, it lends itself to a targeted, time-limited treatment approach to effectively treat seasonal depression during the fall and winter months when people need it most. This also provides a rationale for offering additional TMS to those who have previously responded to TMS to minimize or prevent the risk of recurrence during seasonal risk periods.”
Despite these promising findings, this study has limitations. Of note, this was a retrospective analysis, meaning we looked back at existing data rather than setting up a new experimental design. Although valuable, this approach does not provide the control and randomization of prospective studies. The study also lacked a sham control group, which is often used to measure placebo effects.
“Given that this was not a randomized controlled trial, we still did not know what the 'active ingredient' was in the improvements we were looking at,” Jacob explained. “Non-specific aspects of coming to treatment, i.e. behavioral activation of leaving home and coming to the hospital every day for 4-6 weeks, and/or brief social contact with the nurse's rTMS operator during treatment sessions. We also don't know whether the combination of phototherapy and rTMS is better than either treatment alone, which is something we would like to study in the future.”
This study serves as an important stepping stone for further research. Prospective controlled trials may provide more definitive conclusions about the effectiveness of rTMS and its long-term benefits in preventing the onset of seasonal depression.
the study, “Seasonal patterns and depression consequences of repetitive transcranial magnetic stimulation” is written by Enoch Ng, Sean M. Nestor, Jennifer S. Rabin, Clement Hamani, Nir Lipsman, and Peter Giacobbe.
