The Long-lasting Effect of MRI-Enhanced TMS on Revolutionizing Depression Therapy

This clinical study found that transcranial magnetic stimulation (TMS) directed by MRI can effectively reduce severe depression and sustain improvements for six months, ultimately enhancing quality of life. This has led to its adoption by National Health Service (NHS) Mental Health Trusts. Image credit is given to SciTechDaily.com.

Transcranial Magnetic Stimulation (TMS), guided by Magnetic Resonance Imaging (MRI), has been verified in a major clinical trial to significantly alleviate symptoms of severe depression for half a year.

The trial found that, when an MRI and tracking technology are used to guide magnetic brain stimulation in severely depressed patients, their symptoms can be clinically reduced for a minimum of six months, which could potentially enhance their quality of life immensely.

The trial's results, published in Nature Medicine, showed that participants on average experienced substantial improvements in the severity of their depression, anxiety, and cognitive function, as well as their quality of life, over 26 weeks with MRI neuronavigated TMS. This was a significant extension compared to previously reported improvements seen in only one to three months.

The trial, named BRIGhTMIND, a randomized controlled study, was conducted by University of Nottingham experts and sponsored by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership. It took place across five centers in England: Nottingham, Camden and Islington, Newcastle, Northampton, and Oldham.

TMS is conducted on an outpatient basis, where individuals receive strong magnetic pulses to the left side of their head, just in front of the temporal scalp area. Patients undertake 20 sessions spanning four to six weeks. The precise targeting of the treatment area now demonstrates more durable benefits of this long-established treatment for severe depression.

Depression is a foremost cause of disability years lost worldwide (WHO, 2017), and the biggest killer in people aged between 15-49 is suicide resulting from depression. Treatment-resistant depression (TRD), a condition where two rounds of antidepressants do not alleviate symptoms, affects one-third of depression patients. Antidepressants and therapy, meant to help the remaining two-thirds, are the first or second-line treatments.

The trial aimed to prolong the effects of TMS at least to six months, suggesting that TRD patients responsive to the treatment might only require one or two yearly treatment courses to remain symptom-free and relatively healthy.

The trial, the world's first of its size examining six-month outcomes, implies that this feat may be realized by employing functional MRI alongside TMS to identify the exact brain target area. Normally, MRI is not used to deliver this treatment.

The team utilized a computerized neuronavigation tracking system using light to provide TMS, which allows precise targeting of the stimulation area for all 20 treatment sessions.

Richard Morriss, who is Professor of Psychiatry at the University of Nottingham's School of Medicine and Lead for the Centre for Mood Disorders at its Institute of Mental Health, describes the neuronavigation as reducing the variability in stimulation during every session due to the focused magnetic pulse, which implies minor short-lasting side-effects, allowing the individual to resume daily activities upon hospital return.

In total, 255 individuals were part of the trial, each completing 20 TMS sessions. The patients, already under specialist mental health care, were referred by their GP.

Response to treatment was seen in over two thirds of participants and a third of them exhibited a 50% improvement in their symptoms. One fifth managed to transition into remission and maintain it.

According to Professor Morriss, considering these patients' average previous treatment non-response rate of 7 years, the significant response rate and maintained response rate are quite encouraging.

He adds: “Patients who responded to the treatment could stay relatively well compared to how they were previously, with as little as one or two treatments a year. The changes we saw were substantial, not only in reducing their depression symptoms, but they were large enough to improve concentration, memory, anxiety and subsequently their quality of life. The results have already persuaded three NHS Mental Health Trusts, including Nottinghamshire Healthcare NHS Foundation Trust, to routinely offer new TMS services for treatment resistant depression.”

One of the participants of the trial said: “It has been a privilege to work alongside the research and clinical teams and feel that you are making an important contribution to such a groundbreaking study from a patient perspective. The next challenge is to make transcranial magnetic stimulation a standard and universally available treatment option for difficult to treat depression.”

Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “Once again, high-quality research funded by NIHR and MRC is making a step change in improving health and care services. It’s brilliant to see three UK mental health trusts are now routinely offering TMS to patients following robust evidence from this study.

“These are important findings showing this novel technique can hugely benefit patients with severe depression which has not responded to other treatments.”