Could magnetic pulses help beat teen depression?

by Anne Crawford

A study showing that repetitive Transcranial Magnetic Stimulation (rTMS) reduced depression and anxiety in young people has pointed to factors suggesting who would be most likely to benefit from the treatment.

TMS, a non-invasive, well-tolerated procedure that uses magnetic pulses to stimulate nerve cells in the brain, is well-established as a treatment for depression in adults but little research has been conducted to test its use in young people.

Dr Manreena Kaur from the Monash Alfred Psychiatry Research Centre (MAPrc) was first author on the study, which was conducted at the University of Sydney as a collaboration between Monash University and University of Sydney researchers, and published in Psychiatry Research.

Dr Kaur said it was vital that new treatments for young people with depression were studied.

“It’s really important because the onset of disease most commonly occurs between the ages of 15 and 25 and we have limited treatment options for this age group,” Dr Kaur said. “We know that providing treatments early in the course of illness is likely to result in better outcomes.”

Dr Manreena Kaur

TMS has been shown to be effective in between 30-60% of adults with depression and is typically used in people for whom antidepressants have failed. It delivers repetitive magnetic pulses via an electromagnetic coil placed against the scalp near the forehead. It has the advantage of not having the side effects of some medications, such as weight gain and sexual dysfunction, although mild headaches could be experienced and there is an extremely rare chance of seizure. TMS works by stimulating nerve cells in a region of the brain critical for mood control and depression. This has flow-on effects to other regions implicated in depression.

The study tested 16 people aged 18 to 29, inpatients at St Vincent’s Private Hospital in Sydney and outpatients from Headspace centres, who were given four weeks of treatment. The participants were tested for depressive symptoms, anxiety symptoms and cognition (such as memory and attention) before and after treatment.

It marked the first time in a young adult sample that a reduction in anxiety in addition to depression was observed, researchers said.

Importantly, it found that patients with better cognitive flexibility and verbal learning experienced greater improvements in depressive symptoms with rTMS treatment, providing the first evidence that these measures could be used to predict the outcome of rTMS in depressed young people.

“TMS is a huge investment in time – four weeks of treatment with half-hour sessions five days a week – and is not available through government rebates currently so we really want to focus on trying to find predictors of response to determine who’s going to benefit to try to target the treatment to those people,” Dr Kaur said.

The investigation, while exploratory, showed some promising results for rTMS as an early intervention strategy for young adults with depression, however larger clinical studies with a placebo group were needed, Dr Kaur said.

Dr Kaur works in MAPrc’s Therapeutic Brain Stimulation division, which researches cutting-edge neuroscience technology to explore brain function and to develop and apply innovative treatments across a range of disorders.

She is participating in a suite of innovative studies being launched trialling a form of electrical stimulation called Transcranial Alternating Current Stimulation (tACS) in the homes of the people with various disorders. tACS delivers a small, pulsed, alternating current to the brain via a device plugged into a headset.

While Dr Kaur will enlist the device to further her research into youth depression, Associate Professor Kate Hoy is using remotely supervised brain stimulation to test if it improves cognitive performance in people with Mild Cognitive Impairment (MCI) and, in another study, Alzheimer’s disease.

Trialling remotely supervised devices is new for the division.

“We wanted to do something that was more accessible for people, to avoid the situation where the patient had to come in every day over four to six weeks for 20 minutes of stimulation,” Associate Professor Hoy said.

“The development of the technology has allowed us to look at giving this treatment at home in a way that is a safe, usable and easy,” she said.

“It’s early days yet but if it works then it may lead to the introduction of a new therapy that could help to stall the progression of dementia.”

Professor Ian Hickie and Associate Professor Elizabeth Scott from the University of Sydney, and Professor Paul Fitzgerald and Associate Professor Kate Hoy were instrumental in Dr Kaur’s project.

Kaur M, Naismith SL, Lagopoulos J, Hermens DF, Lee RSC, Carpenter JS, Fitzgerald PB, Hoy KE, Scott EM, Hickie IB. Sleep-wake, cognitive and clinical correlates of treatment outcome with repetitive transcranial magnetic stimulation for young adults with depression. Psychiatry Res. 2019 Jan;271:335-342. doi: 10.1016/j.psychres.2018.12.002. Epub 2018 Dec 1.

For more about TMS and young people
https://kids.frontiersin.org/article/10.3389/frym.2019.00026

For more on the treatment tools being used and developed at the Therapeutic Brain Stimulation division
http://www.maprc.org.au/research-and-treatment-tools