For those with severe depression, relief could soon be just an MRI away.
In a major clinical trial, researchers from the University of Nottingham in the U.K. applied transcranial magnetic stimulation (TMS) to the brains of 255 patients with treatment-resistant depression over a total of 20 sessions.
The patients reported “substantial improvements” in their symptoms and quality of life for at least six months after the procedure, according to a press release from the university.
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More than two-thirds of participants responded to the treatment, with a third showing 50% improvement in symptoms.
For one-fifth of the patients, their depression did not return.
“Given that these patients are people who have not responded to two previous treatment attempts and have been ill for an average of seven years, to get such a significant response rate and a fifth who have a sustained response is really encouraging,” lead researcher Richard Morriss, professor of psychiatry at the University of Nottingham, said in the release.
The findings were published in the journal Nature Medicine on Jan. 16.
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“Transcranial magnetic stimulation is a well-established treatment for depression that is available in many but not all centers, unlike antidepressants, ECT and psychological treatments, which are available anywhere,” Morriss.
Previously, TMS has been delivered in a less effective and precise way, Morriss said, and the results didn’t last as long.
“The importance of this research is that for the first time, in a large enough randomized controlled trial, the benefits on depression lasted six months or more,” he said.
“Not only that, but on average, one in two people [who received] the TMS had a substantial benefit in depression lasting at least six months — enough to improve their anxiety and make them think clearly, function better and have a better quality of life.”
The researchers used an MRI scan to personalize the site of the magnetic stimulation for each patient, Morriss noted.
“We used a neuronavigation system, or tracking system, to ensure that the same site was hit for all 20 TMS sessions, [even] if the person sat in a slightly different position or moved slightly,” he said.
Ninety-two percent of the study participants completed the full treatment, said Morriss, with only “minor side effects” that lasted less than a day.
“People went to the hospital and could resume their usual activities, and they could drive there and back for this treatment,” he said.
Although the MRI-guided treatment costs about 25% more than the traditional TMS treatments, Morriss said the benefits last longer — “so maybe the person only needs one or at the most two courses of treatment per year.”
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The study did have some limitations, Morriss acknowledged.
The researchers were not able to include a placebo group, as it was deemed “ethically and clinically unacceptable” to give a placebo treatment for as long as six months to such a seriously ill group of people, he said.
“So we do not know for sure how much of the TMS effect is real and how much is due to other factors,” he noted. “It seems likely that a high proportion of the effect is due to TMS.”
Not every center offering TMS can access MRI technology, Morriss said, but many sites across the U.S. and Canada do have the equipment.
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“The additional cost and lack of availability of MRI or the expertise to use it is something that doctors and insurers will need to consider,” he added.
Alex Dimitriu, M.D., a psychiatrist and founder of Menlo Park Psychiatry & Sleep Medicine in California, was not involved in the Nottingham study but reviewed the findings.
“There is no doubt that magnetic brain stimulation can be an effective treatment for depression, and this study, using targeted magnetic pulses, further reinforces the efficacy of this treatment,” he said.
A similar type of focused magnetic therapy was developed at Stanford, which found similar strong positive outcomes, Dimitriu said.
“Notably, these therapies can be expensive and somewhat time-consuming — however, the benefits to people who have suffered for years are quite remarkable,” he said.
For anyone dealing with a treatment-resistant psychiatric condition, Dimitriu emphasized the importance of correcting and optimizing sleep before gauging the effectiveness of any treatment.
In 2023, 29% of Americans reported having been diagnosed with depression at some point in their lives, while 17.8% said they currently suffer from it.