How the brain changes in the treatment of depression

Researchers at the University of British Columbia have mapped what happens to the human brain when treating depression, known as recurrent transcranial magnetic stimulation.

New research shows how the brain changes in the treatment of depression

Researchers have for the first time shown what happens in the brain during repetitive transcranial magnetic stimulation, a treatment for depression (rTMS). The results were announced on May 18, 2022 American Journal of Psychiatry.

When other strategies, such as medications, cannot help a patient with their depression, rTMS is often used as a treatment. Antidepressants are considered ineffective for about 40% of people with severe depression.

During the rTMS session, a device with an electromagnetic coil was pressed into the patient’s scalp. The device then transmits a painless magnetic pulse, which stimulates nerve cells in the dorsolateral prefrontal cortex, a part of the brain involved in regulating mood.

Although rTMS has been shown to be effective, the mechanisms behind its effects on the brain are still poorly understood.

“When we first started this study, the question we were asking was very simple: we wanted to know what would happen to the brain when rTMS treatment was delivered,” says Dr. Fidel Vila-Rodriguez is an assistant professor of psychiatry at the University of British Columbia and a researcher at the Javad Movafagian Center for Brain Health (DMCBH).

To answer this question, Dr. Vila-Rodriguez and his team delivered a round rTMS to patients while they were inside a magnetic resonance imaging (MRI) scanner. Because MRI can measure brain activity, researchers have been able to see changes in the brain in real time.

The team found that several other areas of the brain were also activated by stimulating the dorsolateral prefrontal cortex. These other areas are involved in several functions, from controlling emotional responses to memory and movement control.

Participants then assessed whether fewer patients had a four-week treatment and a team with activated areas of symptoms associated with depression, and whether their treatment was completed.

“We found that areas of the brain activated during parallel rTMS-fMRI were significantly associated with better outcomes,” says Dr. Villa Rodriguez.

With this new map, rTMS stimulates different areas of the brain, Dr. Villa Rodriguez hopes the findings could be used to determine how well a patient responds to rTMS treatment.

“By demonstrating this principle and identifying areas of the brain processed by rTMS, we can now try to understand that this pattern can be used as a biomarker,” he says.

Dr. Vila-Rodriguez is currently studying how rTMS can be used to treat a number of neuropsychiatric disorders. It was funded by the Javad Movafagian Brain Health Center[{” attribute=””>Alzheimer’s Disease Research Competition to look at rTMS as a way to enhance memory in patients who are showing early signs of Alzheimer’s disease. He also received a grant from the Canadian Institutes of Health Research (CIHR) to study whether the rTMS brain activation patterns can be detected by changes in heart rate.

Dr. Vila-Rodriguez says this type of research will hopefully encourage more widespread adoption and accessibility of rTMS treatments across the country. Despite being approved by Health Canada 20 years ago, rTMS is still not widely available. In British Columbia, there are some private clinics that offer rTMS, but it is not covered by the provincial health plan.

This research was a collaborative effort across the Centre for Brain Health, including DMCBH researchers Dr. Sophia Frangou, Dr. Rebecca Todd, and Dr. Erin MacMillan, as well as members of the University of British Columbia’s MRI Research Centre including Laura Barlow.

Reference: “Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial” by Ruiyang Ge, Afifa Humaira, Elizabeth Gregory, Golnoush Alamian, Erin L. MacMillan, Laura Barlow, Rebecca Todd, Sean Nestor, Sophia Frangou, and Fidel Vila-Rodriguez, 18 May 2022, American Journal of Psychiatry.
DOI: 10.1176/appi.ajp.21050541

Leave a Comment

Your email address will not be published.