The following are commonly used brain stimulation methods that we undertake at The Neuroscience Center.
ECT is most often used to treat severe, treatment-resistant depression, but it may also be medically indicated in other mental disorders, such as bipolar disorder or schizophrenia. It also may be used in life-threatening circumstances, such as when a patient is unable to move or respond to the outside world (e.g., catatonia), is suicidal, or is malnourished as a result of severe depression.
ECT can be effective in reducing the chances of relapse when patients undergo follow-up treatments. Two major advantages of ECT over medication are that ECT begins to work quicker, often starting within the first week, and older individuals respond especially quickly.
In 2008, rTMS was approved for use by the FDA as a treatment for major depression for patients who do not respond to at least one antidepressant medication in the current episode. It is also used in other countries as a treatment for depression in patients who have not responded to medications and who might otherwise be considered for ECT.
The evidence supporting rTMS for depression was mixed until the first large clinical trial , funded by NIMH, was published in 2010. The trial found that 14% achieved remission with rTMS compared to 5% with an inactive (sham) treatment. After the trial ended, patients could enter a second phase in which everyone, including those who previously received the sham treatment, was given rTMS. Remission rates during the second phase climbed to nearly 30%. A sham treatment is like a placebo, but instead of being an inactive pill, it’s an inactive procedure that mimics real rTMS.
VNS was originally developed as a treatment for epilepsy. However, scientists noticed that it also had favorable effects on mood, especially depressive symptoms. Using brain scans, scientists found that the device affected areas of the brain that are involved in mood regulation. The pulses appeared to alter the levels of certain neurotransmitters (brain chemicals) associated with mood, including serotonin, norepinephrine, GABA and glutamate.
In 2005, the U.S. Food and Drug Administration (FDA) approved VNS for use in treating treatment-resistant depression in certain circumstances:
- If the patient is 18 years of age or over; and
- If the illness has lasted two years or more; and
- If it is severe or recurrent; and
- If the depression has not eased after trying at least four other treatments
According to the FDA, it is not intended to be a first-line treatment, even for patients with severe depression. And, despite FDA approval, VNS remains an infrequently used because results of early studies testing its effectiveness for major depression were mixed. But a newer study , which pooled together findings from only controlled clinical trials, found that 32% of depressed people responded to VSN and 14% had a full remission of symptoms after being treated for nearly 2 years.
Deep brain stimulation (DBS) was first developed as a treatment for Parkinson's disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest. Stimulation is continuous and its frequency and level are customized to the individual.
DBS has been studied as a treatment for depression or obsessive compulsive disorder (OCD). Currently, there is a Humanitarian Device Exemption for the use of DBS to treat OCD, but its use in depression remains only on an experimental basis. A review of all 22 published studies testing DBS for depression found that only three of them were of high quality because they not only had a treatment group but also a control group which did not receive DBS. The review found that across the studies, 40-50% of people showed receiving DBS greater than 50% improvement.
The invention of combination therapy (co-administration of ES or TMS & ketamine) is a tool unique to The Neuroscience Center. We discovered a method to target drug delivery and heighten the pharmacologic effect of ketamine by stimulating the brain with non-invasive methods (TMS, tES) during the administration of ketamine. We have been able to increase response from ⅔’s of all patients to over 90% of patients, and to take response from the very short window of relief (4 - 7 days) to semi-permanent. A very large percentage of our patients have enjoyed ongoing relief (as long as 5 years) from previously treatment refractory illness like depression or neuropathic pain. The process was patented and awarded to Dr. Best in 2014.