Depression is one of the most common types of mental illness. Estimated to affect over 17 million people in the United States, it can afflict anyone at any time. Patients commonly report feelings of sadness, fear, hopelessness, and worthlessness, even if everything else in their lives seems to be going well. Depression can impact anything from sleeping and eating patterns to concentration and memory, and often occurs with other serious medical conditions including heart disease, cancer, and stroke. While there are many effective therapies available for patients today, such as medications and talk therapy, depression may be resistant to these treatments.
In 2008, patients were granted a potential reprieve from this life altering condition when the FDA approved the use of repetitive transcranial magnetic stimulation (rTMS, often referred to as just TMS) for treatment resistant depression. TMS is a non-invasive technique that excites neurons in the brain via magnetic pulses passed through the scalp. It is a safe and effective, non-drug treatment with minimal side effects for patients with major depression who have not responded to other treatments. Penn’s Department of Psychiatry was at the forefront of researching the use of this breakthrough therapy for patients with major depression and continues to be a leading center utilizing this approach.
Penn Medicine is currently one of the first research sites in the country that is testing the effectiveness of another non-invasive, medication-free treatment called synchronized transcranial magnetic stimulation (sTMS). This is a new brain stimulation treatment that may also help alleviate symptoms of depression. The sTMS system uses low energy, synchronized transcranial magnetic stimulation synchronized to an individual’s natural brain rhythms as opposed to the stronger, high-frequency pulses utilized with traditional rTMS. Penn is one of only 16 sites in the country testing this new technology.
“sTMS is an exciting new development in psychiatry since it offers the potential for an additional non-pharmacological treatment for the disabling symptoms of depression,” says Mahendra Bhati, MD, assistant professor of Clinical Psychiatry, who, along with Michael Thase, MD, professor of Psychiatry and chief, Division of Mood and Anxiety Disorders Treatment & Research Program, is researching the new treatment at Penn. “Many patients can’t tolerate medications and TMS can be an effective treatment for these patients. sTMS is unique when compared to all other treatments in psychiatry since sTMS uses physiological markers of brain activity to tailor treatment. This offers the hope of individualized and potentially more effective treatment for the disabling and difficult to treat symptoms of depression.”
So how exactly does it work? Research has shown that the neuronal activity in the brains of people with depression shows abnormal brain rhythms in areas associated with depressive symptoms. sTMS therapy is based on the theory that the brain rhythms can be “tuned” to a normal resting rhythm using low energy magnetic fields synchronized to an individual’s brain activity. It is believed that this will restore normal brain rhythms leading to a reduction of depression symptoms and improved mood. Unlike conventional rTMS or medications, this type of magnetic stimulation is tailored to a patient's individual brain physiology.
More research is needed to determine the safety and efficacy of sTMS and the system is not yet FDA approved. Data from preliminary studies have shown that sTMS can improve depressive symptoms in a significant number of patients. The ongoing study at Penn and other sites seeks to confirm the findings from earlier studies and obtain FDA approval for sTMS when treating depression.
“They also have plans to make the device portable so it can be used at home where you can plug into the wall and listen to a built-in mp3 player. It's painless, relaxing, and a physiologically tailored treatment for depression," says Dr. Bhati. "If it works, it may be a treatment patients can administer to themselves in the convenience of their own home, unlike rTMS which requires five times a week visits to a doctor’s office.”
Researchers are hopeful that this kind of personalized approach to depression treatment will offer patients a greater variety of options to treat depression. Learn more about this trial and other depression research at Penn.