Clinical trial probes accelerated delivery of non-invasive brain stimulation to knock out depression in a week

Five-day protocol involves more than 200 participants in Ontario and B.C. as part of a trial funded by Brain Canada and Bell Let’s Talk

A major clinical trial of accelerated theta-burst brain stimulation, funded by Brain Canada and Bell Let’s Talk, holds the promise of potentially easing the debilitating symptoms of treatment-resistant depression within a week.

This study is an example of the kind of clinical research needed to advance care. These types of studies are very hard to conduct but the outcomes have the potential to change practice. I can’t promise what the outcomes will be of this trial, but I can promise we will have a clearer understanding of the efficacy of this approach at the end of the trial.

Trial leader Dr. Daniel Blumberger, a clinician-scientist at the Centre for Addiction and Mental Health (CAMH) in Toronto

Pioneered for clinical use at CAMH and other centres in Canada, intermittent theta-burst stimulation (TBS) is a form of non-invasive transcranial magnetic stimulation (rTMS) that delivers magnetic pulses to target and modulate the brain’s circuitry. TBS uses a different pattern of stimulation than traditional rTMS, and single sessions take about three minutes, instead of 20 or 30 minutes using the standard approach.

More than 200 adults, ages 18 to 65, have been recruited to participate in the large randomized clinical trial (RCT). Most participants are people who have not responded to standard first-line treatments for depression, such as medications or psychotherapy.

During the trial, Dr. Blumberger and his colleague, Dr. Fidel Vila-Rodriguez of the University of British Columbia, will compare eight sessions of TBS per day over five days (40 sessions in total) to sham stimulation, which mimics the experience of real stimulation without using significant currents, over the same period. The goal is to see if the depression can be treated very rapidly.

Depression outcomes will be measured right after treatment and four weeks later. Researchers are also looking at sex-specific differences in the response to the therapy.

Because this RCT will produce strong evidence (RCTs are considered the gold standard for clinical medicine), Dr. Blumberger says “if the accelerated treatment does better than the sham, then theoretically people could start offering this five-day-a-week treatment as an option to patients.”

A fast-tracked treatment would be particularly beneficial “in countries like ours where people travel great distances to get their health care. This approach could shorten the number of visits to the clinic to a week instead of six weeks,” Dr. Blumberger adds.

Effective treatments that people tolerate and want to access are desperately needed because depression is a major health concern in Canada. As many as one in three Canadians experience depression in their lives and not everyone responds to standard therapies.

While not covered by all provincial health care plans, non-invasive transcranial magnetic stimulation is becoming more available, and mental health practitioners are confident that the introduction of public programs will make the treatment more readily accessible very soon.

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