When Tommy Van Brocklin signed up for a trial of a special type of magnetic brain stimulation therapy that could potentially ease his depression, he had already been living with the mood disorder for 45 years.
Van Brocklin, 60, first underwent an MRI that located the part of his brain that regulates executive functions such as problem-solving and inhibits unwanted responses.
Then for five days, for 10-minute sessions 10 times each day, doctors used repeated pulses to stimulate the part of his brain that could impact his depression.
“I was kind of at the end of my rope, very frustrated with it all,” Van Brocklin said about how he felt before trying the treatment. “I never knew when it was going to be a good day and when it was going to be a bad day. Just could never get on top of it, you know? Well, maybe I would for a while and then it would go right back into it.”
While at first Van Brocklin noticed no change, by day two he felt emotional and by day three he could tell it was working in a way that medications and talk therapy no longer did for him.
“The third day, I guess it kicked into gear, and I started to get better and better and better,” Van Brocklin said. “The treatment seems to show me that there is enjoyment in everyday things, the small things, like walking my dog just for the enjoyment of it, or playing my guitar for the fun of it.”
The treatment, called SAINT, is an intensive, individualized form of transcranial magnetic stimulation (TMS). In the new trial, researchers worked with 29 individuals who had severe depression that was resistant to other treatments. About half of the participants received SAINT. The other half had a placebo that was meant to mimic the real treatment with a magnetic coil that felt like a magnetic pulse
The relief came quickly, within days, and was successful for 78.6% of the treatment group. They were found to be no longer depressed in standard evaluations. Side effects were temporary fatigue and headaches.
Study author Dr. Nolan Williams, an assistant professor in the Department of Psychiatry at Stanford University, was motivated to provide a quicker solution for people who had psychiatric emergencies. The solution would also be an alternative to electroconvulsive therapy, which is used by only about 1.5% of people to treat a suicidal depressive episode for a variety of reasons, he said.
New treatment could work faster in emergencies
“The vast majority of people who come in with suicidal depression in the United States, into U.S. psychiatric hospitals, don’t have access to any sort of emergency intervention. That’s coupled with the other data that suggests or demonstrates that people who are in these sort of suicidal depressive episodes have the highest lifetime risk of completing a suicide attempt after they get discharged from their first inpatient hospital stay for a mood disorder,” Williams said. “The No. 1 risk for suicide is previous suicide attempt. The No. 2 risk for suicide is hospitalization prior to that attempt.”
Williams said he became convinced that something like this was needed. TMS in its current, U.S. Food and Drug Administration-approved form works over a longer period of time, about six weeks, so it is not as useful to someone who will only be an inpatient on a suicide hold for about 10 days. SAINT works more quickly. About half the patients who have standard TMS improve, and one-third experience remission from depression.
“We figured out a way to compress an entire six-week course of TMS into a single day. And so then we’re able to give five times as much stimulation, and there’s a bunch of new neuroscience, basically, in how to rearrange those pulses in time and in space,” Williams explained.