THERAPEUTIC MAGNETS APPEAR TO LIFT MOOD IN CERTAIN DEPRESSED PATIENTS

April 1998

Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

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Dark moods are lightened for many patients with medication-resistant depression who are stimulated with therapeutic magnets, according to recently published data from researchers at the Emory University School of Medicine.

In the largest study to date of rapid rate transcranial magnetic stimulation (rTMS), 56 percent of young and middle aged study subjects (22-65 years of age) and 23 percent of subjects over age 65 participating in the Emory study responded positively to the experimental treatment. Findings of the 50-patient series are published in the March issue of the Journal of Neuropsychiatry and Clinical Neurosciences. The study also is the first to evaluate rTMS in older patients with depression.And in the January issue of Psychiatric Annals, Emory researchers reported that 56 percent (16 of 28) of young and middle-aged persons with depression responded favorably to rTMS.

Emory researchers William McDonald, M.D., assistant professor of Psychiatry and Behavioral Sciences, and Charles Epstein, M.D., associate professor of Neurology, currently are recruiting participants for further rTMS studies. Candidates should have depression that has not responded well to conventional treatment. Call 404/ 728-4558 for information.

"Future studies will need to examine the best ways to give rTMS and the long-term management of patients who receive it, while remaining alert for any possible risks," says Dr. Epstein, first author of the Psychiatric Annals paper.

During treatment sessions, doctors place a powerful magnetic coil close to the top of the patient's head, near the portion of the brain believed to improve the mood of depressed patients (the left pre-frontal cortex). The coil is not an ordinary magnet.

"An electromagnetic field is induced over the region for a few seconds, apparently stimulating neurons to fire more effectively," says Dr. McDonald, who runs Emory's electroconvulsive therapy (ECT) treatment and research programs.

For patients involved in the study reported in Psychiatric Annals, for instance, 10 Hertz electromagnetic stimulation was delivered in 10 trains of five seconds each. The regimen was repeated in each study subject on an outpatient basis for five consecutive weekdays.

Patients sit or lie down during the short procedure and require no anesthesia nor sedation. Most feel mild tightening of the scalp muscles, and a small percentage report headaches that end as soon as stimulation ends.

"Both electromagnetic stimulation and electroconvulsive therapy provide a safe treatment for depression that is resistant to antidepressant medication," Dr. McDonald says. "Both seem to positively influence brain function through nerve cell stimulation, though the precise antidepressant mechanism of action of the therapies is unknown. Approximately one in five people will have a serious episode of depression during their lifetime, yet 20 percent of depressed patients will have little or no response to medication and an additional 20 to 30 percent will respond only partially to medication. Rapid rate TMS appears to benefit some patients in whom medication has been ineffective."

Work at Emory and the other sites investigating rTMS also provides evidence on the neuroanatomy of depression. Patients with early onset depression have deficits in the neuronal transmission primarily in the outer, or cortical, areas of the brain compared to patients with late onset depression (depression with the onset after age 50 years) who have deficits in the deep areas of the brain known as the subcortical nuclei. As expected, the persons with early-onset depression benefit more from rTMS (rTMS stimulates only cortical areas in the outer areas of the brain) compared to older adults who the suffer from late-onset depression associated with dysfunction in the deeper, subcortical regions of the brain. Patients in these preliminary studies who were older and had the onset of their depression early in life responded to rTMS at three times the rate of the older patients with late-onset depression. Fortunately the patients with late onset depression who have failed traditional antidepressant medication respond to ECT at a rate of approximately 80 to 90 percent, Dr. McDonald says Rapid rate TMS has several advantages over ECT. Rapid rate TMS is noninvasive and is potentially a more convenient treatment option. The researchers say patients could potentially receive rTMS treatments during their lunch hour daily for a few weeks, without missing time from work. Since ECT requires intravenous administration of general anesthesia, patients cannot drive for several hours after a session and usually miss a day of work.

The first three Atlanta study subjects received rTMS at the Atlanta Veterans Affairs Medical Center (AVAMC) under the direction of Aida Saldivia, M.D., and Susan Glover, M.D. All Emory study subjects have since received the investigational treatment in the

ECT Suite of the Mood Disorders Center located at Wesley Woods Geriatric Hospital, utilizing equipment loaned by the Rehabilitation Research and Development Center at the AVAMC.

Other support for the Emory research has come from the J.B. Fuqua Foundation and from Neotonus, Inc.

ELECTROMAGNETIC THERAPY for DEPRESSION

b a c k g r o u n d

BRIEF HISTORY

-- In addition to mood, transcranial magnetic stimulation has been used to evaluate brain function in vision, memory, attention, speech and movement, including Parkinson's disease.

-- Medical University of South Carolina professor Mark George conducted early work applying rTMS to the treatment of depression while he was at the National Institute of Mental Health. He reported in 1994 that two of six treatment-resistant patients improved after prefrontal cortex stimulation by rTMS.

-- Alvaro Pascual-Leone, currently at Brigham and Women's Hospital in Boston, conducted a crossover placebo controlled study with five different treatment conditions. His team reported in 1996 that 11 of 17 patients under 60 years of age with psychotic or drug-resistant depression benefited from left pre-frontal electromagnetic stimulation.

THE PSYCHIATRIC ANNALS PAPER

Charles M. Epstein, M.D., Gary S. Figiel, M.D., William M. McDonald, M.D., Jody Amazon-Leece, MS, GNP, and Linda Figiel, RN, MSN "Rapid Rate Transcranial Magnetic Stimulation in Young and Middle-Aged Refractory Depressed Patients" Psych Annals 28:1/January 1998.

-- Thirty-two patients were enrolled (16 women, 16 men) in the study and 28 completed the five days of rTMS treatment administered by Emory University School of Medicine physicians at Wesley Woods Geriatric Center. Ages ranged from 22 to 64 years with a mean age of 40. All pat