This double-blind randomized clinical trial was conducted with 29 participants with treatment-resistant depression, and 78.6% of the treatment group were no longer depressed after 5 days of treatment. Based on these findings, SNT may hold a great deal of promise for individuals who struggle to find relief from severe depression.
The Research
In this study, participants ranged in age from 22 to 80 and had dealt with depression for nine years on average, despite trying pharmacotherapy. Historically, transcranial magnetic stimulation (TMS) treatment has required six weeks of once-daily sessions, but SNT targeted the magnetic pulses according to each patient’s neurocircuitry, based on an MRI. Within 4 weeks of treatment, 12 of the 14 participants who had received the SNT treatment had improved, and 11 of them met the Food and Drug Association (FDA) criteria for remission, while only 2 of the 15 participants who had received the active placebo met the criteria for remission. While these findings are promising, a limitation of this research is its small highly educated sample size, which reduces generalizability. Another limitation of this study is the fact that 45% of its participants had comorbid psychiatric diagnoses, which may impact the efficacy of treatment.
Potential Game-changer for Severe Depression
Founder of the Stanford Brain Stimulation Lab, and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, Nolan Williams, MD co-developed the Stanford Neuromodulation Therapy (SNT) stimulation technology. Dr. Williams says, “After observing such dramatic results in our open-label study, where 90% of the participants entered remission of their depressive symptoms after treatment with SNT, we set up a double-blind, randomized controlled study, considered the gold standard of science.” SNT uses electromagnetic pulses to mimic the language of the brain, so Dr. Williams explains how MRI techniques uncover each patient’s unique brain networks so that treatment can target specific brain circuits and retrain the brain through a series of magnetic pulses that induce brain activity. Dr. Williams explains, “By speaking to the brain in its own language, the time commitment from the patient has been reduced from 6 weeks to 5 days, and the effectiveness of TMS treatment is dramatically improved.” Since the protocol uses higher doses than repetitive transcranial magnetic stimulation (rTMS) in optimally spaced intervals, Dr. Williams notes that these patterns of stimulation provide time for the brain to build proteins to rewire itself, resulting in sustained changes in neural circuits. Mental health emergencies can be particularly difficult to manage, but Dr. Williams highlights how SNT may be a game-changer. “For example, if you have a heart attack or a stroke, you can go to the hospital and receive sophisticated treatments that are only available at the hospital,” he says. Options increase as the acuity of the illness increases but Dr. Williams notes, “If a person is experiencing a mental health emergency and goes to the hospital, the same options aren’t there, and the ability to receive more effective treatment in the hospital is drastically reduced or non-existent.” Dr. Williams further explains, “More than 550,000 American adults are hospitalized annually for suicidal depression. The highest peak in suicide attempt and completion is immediately after discharge from the hospital.” When people have tried everything medicine has to offer to treat their depression, they can feel hopeless, but Dr. Williams says SNT offers something new for those with treatment-resistant depression. Dr. Williams highlights, “Mental illnesses and substance use disorders have been rising steadily, and the pandemic has only added fuel to the fire. It’s vital to the state of mental health in America that we continue to further advance treatment and research for illnesses of the brain.”
Another Tool for Severe Depression
Behavioral health medical director at Community Health of South Florida Inc., psychiatrist Howard Pratt, DO, says, “This is another tool in psychiatrists’ toolbox for treating depression. The bottom line here is to not give up on treating depression if you have had treatment fail in the past." Dr. Pratt notes, “The science is there, but for this study, the sample size is smaller than I would like to see. If we see these results with larger groups then we will have a better gauge as to how effective this treatment is.” Since the stigma of seeking mental health treatment may pose a barrier, Dr. Pratt highlights how it sometimes has individuals reaching past the most effective treatment, which is a combination of therapy and medication. Dr. Pratt explains, “This research reminds us we need to keep reaching. I thought the study was brilliant. It’s looking at taking similar TMS treatment, which takes about six weeks to achieve results, which is about the same as for an antidepression medication, down to five days.” When patients talk with their psychiatrist about these innovations, Dr. Pratt recommends that they understand how the standard care is the treatment of choice and should be prioritized as the first line of treatment. Dr. Pratt explains, “The patient and the psychiatrist really have to start with therapy and that means talking, having in-depth conversations before turning to administering magnetic pulses on people’s brains.”
