How the Brain Changes During Depression Treatment

Researchers at the University of British Columbia have mapped what happens in the brain when a person receives the treatment for depression known as repetitive transcranial magnetic stimulation.

New study maps how the brain changes throughout depression treatment

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

When other strategies, such as medication, have failed to help a patient with depression, rTMS is often used as a treatment. Antidepressants are thought to be ineffective for about 40% of people with severe depression.

A device with an electromagnetic coil is pressed onto the patient’s scalp during an rTMS session. A painless magnetic pulse is then delivered by the device, stimulating 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 of its effects on the brain are still poorly understood.

“When we started this research, the question we were asking was very simple: we wanted to know what happens in the brain when rTMS treatment is given,” says Dr. Fidel Vila-Rodriguez, Assistant Professor at the University of British Columbia Department of Psychiatry and a researcher at the Djavad Mowafaghian Center for Brain Health (DMCBH).

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

The team found that by stimulating the dorsolateral prefrontal cortex, several other regions of the brain were also activated. These other regions are involved in multiple functions – from managing emotional responses to memory and motor control.

The participants then underwent another four weeks of rTMS treatment and the team assessed whether the activated regions were associated with patients showing fewer symptoms of depression at the end of their treatment.

“We found that brain regions that were activated during simultaneous rTMS-fMRI were significantly related to good outcomes,” says Dr. Vila-Rodriguez.

With this new map of how rTMS stimulates different areas of the brain, Dr. Villa Rodriguez hopes the results can be used to determine how well a patient is responding to rTMS treatments.

“By demonstrating this principle and identifying brain regions that are activated by rTMS, we can now try to understand if this pattern can be used as a biomarker,” he says.

Dr. Vila-Rodriguez is now exploring how rTMS can be used to treat a range of neuropsychiatric disorders. He received funding from the Djavad Mowafaghian Center for Brain Health

Alzheimer’s disease is a disease that attacks the brain, leading to a decline in mental abilities that worsens over time. It is the most common form of dementia and accounts for 60-80% of dementia cases. There is currently no cure for Alzheimer’s disease, but there are medications that can help relieve symptoms.

” data-gt-translate-attributes=”[{” 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

#Brain #Depression #Treatment

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