Researcher eyes treatment alternative for depression

Individuals suffering from depression – particularly as a result of bipolar disorder – may have renewed hope for an effective treatment with fewer side effects and no stigma attached thanks to a new study and national clinical trial led by a Schulich School of Medicine & Dentistry professor.

Led by Psychiatry professor Amer Burhan, the study is the first randomized controlled trial to examine the efficacy of a new non-medicinal treatment called magnetic seizure therapy (MST), which could prove a promising alternative to electroconvulsive therapy (ECT).

BURHAN

ECT, long proven effective in treating depression, uses an electric field to induce a seizure that provides therapeutic benefit to the patient. However, it also comes with cognitive side effects such as disorientation and amnesia. ECT also carries a stigma that may prevent patients from opting out of treatment.

MST works in a similar way to ECT but uses a focused magnetic field, as opposed to electricity, to induce a seizure, resulting in fewer side effects.

“We’ve had (ECT) since the late 1930s. It’s a very effective treatment. But the main problem has been it tends to send electricity to a broad, diverse area in the brain. That results in cognitive side effects,” explained Burhan, who is also a neuropsychiatrist at St. Joseph’s Health Care London and a researcher at Lawson Health Research Institute.

“The attempt over the years has been to try to find a more focal, streamlined way to induce a seizure without sending energy to areas of the brain that have to do with making memories.”

MST is one way to accomplish just that.

During treatment, high-intensity magnetic field pulses are delivered to the patient’s brain through a magnetic coil. Pulses pass freely into a focused area of the brain and create a seizure while stimulation is limited, leaving surrounding brain tissue unaffected and resulting in minimal cognitive side effects. MST produces an increase in blood flow to the regions of the brain responsible for depressive symptoms.

Depression, much like some infections, can become resistant to medication as a form of treatment, Burhan noted. This leaves some patients with limited options.

While ECT has traditionally been considered the gold-standard therapy for treatment-resistant depression, MST could one day take its place, offering patients effective treatment with fewer side effects and no stigma.

“We use ECT (and could use MST) to treat people who have been resistant to medication and psychotherapy, who continue to suffer, despite trying everything. Brain stimulation treatments are an option because it has a good effect,” Burhan said.

MST has already proven effective in treating major depressive disorder and unipolar depression, he added. His study will evaluate the treatment for depression that results from bipolar disorder.

The clinical trial, led by the Centre for Addiction and Mental Health, will also be offered through Lawson and University of British Columbia (UBC) Hospital. Eligible patients will be randomized to receive either ECT or MST. Patients with the goal of improving patient outcomes in both groups. Patient outcomes will be compared to study the efficacy of MST and whether it is associated with reduced cognitive side effects.

Treatment will be delivered under anesthesia in 12-20 sessions which will last 10-15 minutes each, with 60-90 minutes of recovery time, Burhan explained. If proven as a viable first-line treatment, MST is easy to implement in existing ECT clinics.

“We are going to be treating with anyone with bipolar depression. Anybody with bipolar depression in London could ask for a referral (to the study). But this is just one part of a whole set of studies we are doing to reach a better and more effective way to treat people with depression,” Burhan noted.

In addition to this trial, there are other studies. People suffering from depression can be referred to Burhan’s clinic or others. There are a range of studies to help people and at the same time inform the field and lead to better treatment, Burhan said.