How we treat depression in the future may be set to change as the NHS begins an unprecedented two-year study using transcranial magnetic stimulation (TMS).
The £2m study of 420 patients is the largest of its kind and will use therapy systems provided by Magstim, the pioneer of TMS, a safe, proven and non-invasive outpatient therapy developed over 25 years ago.
In patients with depression, electrical activity in certain areas of the brain is reduced.
Magstim TMS therapy uses a series of repetitive, brief and highly-focused magnetic pulses to stimulate brain cells.
The Magstim Horizon Performance system being used in the study utilises a focused electromagnetic coil to rapidly pulse a magnetic field to the targeted area of the brain. This induces a small electrical current, which stimulates the targeted brain cells into activity, increasing brain activity back to a normal level.
We have changed the way the magnets deliver their energy and using brain imaging we have targeted the stimulus more accurately in each person. By doing this we hope this safe treatment can help more people to stay well for many months at a time
TMS, which has few of the known adverse effects associated with medication or invasive treatments, is accredited by the National Institute for Health and Care Excellence (NICE) and is increasingly being used by practitioners in cases of treatment-resistant depression (TRD) where antidepressant medication is proving ineffective and before invasive treatments like Electroconvulsive Therapy (ECT) are considered.
Four NHS trusts are taking part in the new study, which will look at how targeting individually-identified areas of under activity in a patient’s brain with theta burst TMS affects efficiency and long-term remission.
Half of the participants will then have a ‘personalised’ therapy session, targeting the exact area of their brain identified as being under active, using theta burst TMS - a newer form of TMS that can be delivered in as little as three minutes, versus 37.5 minutes for a standard 10 Hz TMS treatment session. The other half will have a standard TMS therapy session as per the current FDA protocol. The groups will not be aware which treatment they are receiving as each session will appear to last 37.5 minutes.
The study hopes to establish whether a personalised approach to treatment using theta burst TMS offers greater remission rates and longer lasting effects compared to the current TMS protocol.
Northampton’s Berrywood Hospital, Newcastle’s St Nicholas’s Hospital, Nottinghamshire’s Millbrook Mental Health Unit at Queen Medical Centre, and St Pancras Hospital in London are all currently recruiting patients for the study, which will roll out between now and the new year.
Magstim’s Group chief executive, Lothar Krinke, said: “This is an unprecedented study that could inform the future of depression treatment around the world.
“Magstim TMS therapy has already changed the way practitioners are able to treat depression, offering both medical professionals and patients new hope for recovery, and we always encourage further research to see how our technology can further enhance treatment.”
He added: “We are working closely with the four trusts involved in this new study, not only providing our latest therapy system with a new, innovative navigation system that allows even more-accurate targeting with the coil; but also providing expert training to the researchers to ensure they get the best results from the machines.”
This is an unprecedented study that could inform the future of depression treatment around the world
Professor of psychiatry at the University of Nottingham, Richard Morriss, is involved in the study and said: “Treatment-resistant depression is a devastating condition associated with premature death from suicide or poor physical health and an impaired ability to work.
“We have had a limited degree of success with talking therapies and antidepressant drugs. Now we have a safe third option using stimulation by magnets called transcranial magnetic stimulation (TMS).
“We have changed the way the magnets deliver their energy and using brain imaging we have targeted the stimulus more accurately in each person. By doing this we hope this safe treatment can help more people to stay well for many months at a time from rather than a few weeks at a time.
“The treatment is also likely to be more efficient in terms of staff time, so even with imaging and more capital investment, the new treatment is likely to save costs compared to traditional TMS. ”