When a person has to endure symptoms of mental illness because current treatments don’t work for them, the need for alternatives is obvious.
CAMH has been a pioneer in the use of brain stimulation, one of the few new treatment options for mental illness in the past 30 years. CAMH’s Temerty Centre for Therapeutic Brain Intervention is leading innovative studies that suggest this therapeutic approach, which targets the brain’s neural circuits, holds promise for many mental illnesses.
For hard-to-treat depression, repetitive transcranial magnetic stimulation (rTMS) is known to be effective, but the course of treatment, at 45 minutes daily for up to six weeks, is time-consuming and cost-intensive. In a major advance, a study led by Dr. Daniel Blumberger has shown that a new “theta-burst” form of rTMS that takes only three minutes is just as effective as the standard.
Different forms of brain stimulation, including rTMS, transcranial direct current stimulation (tDCS) and magnetic seizure therapy (MST), are being studied as both treatment and investigative tools. “We’re aiming to identify and study biological targets for treatment, and to understand the brain mechanisms underlying disorders,” says Dr. Jeff Daskalakis.
While brain stimulation is not yet a household term, the range of promising studies underway at CAMH suggests it will be in the future. Researchers are exploring the use of brain stimulation to improve memory in schizophrenia, reduce cravings in cannabis addiction, prevent Alzheimer’s dementia, treat post-traumatic stress disorder and mild autism, and more.
A timeline of CAMH impacts in brain stimulation research
Brain stimulation is established
The first transcranial magnetic stimulation (TMS) device is set up at CAMH in 1998 to study brain physiology. By 2002, its use is approved in treatment protocols at CAMH. The first studies in schizophrenia and depression begin within the next two years.
New forms of stimulation
The use of transcranial direct current stimulation (tDCS) in depression begins in 2009, which lays the groundwork for PACt-MD, a large-scale study aimed at preventing Alzheimer’s dementia.
A 2016 CAMH study in JAMA Psychiatry shows that brain cell activity can be measured to predict whether magnetic seizure therapy (MST) reduces suicidal thinking in people with severe depression.
A major multi-site study compares electroconvulsive therapy (ECT) with MST, which may be a more acceptable treatment to patients than ECT.
Effectiveness at three minutes
A 2018 CAMH study in The Lancet shows that half of all patients respond to three-minute theta-burst repetitive transcranial magnetic stimulation (rTMS) and that one-third achieve remission from depression. These patients, whose depressive episodes averaged over two years, had at least one unsuccessful treatment with antidepressant therapy or psychotherapy in the past.
Future directions: PTSD, schizophrenia, autism and more
Different types of brain stimulation are investigated to treat a range of symptoms and to identify brain mechanisms in depression, autism, PTSD, schizophrenia and addiction.
Clinical and regulatory changes for a new treatment technology
The first device
A prototype transcranial magnetic stimulation device is built in 1985 in the United Kingdom to study brain physiology. By the mid-1990s, studies begin on depression treatment.
Health Canada approval
In 2002, Health Canada approves repetitive transcranial magnetic stimulation (rTMS) to treat depression that hasn’t responded to other treatments. The U.S. Food and Drug Administration follows suit in 2008.
In 2016, Health Quality Ontario recommends that rTMS be funded for patients with treatment-resistant depression when ECT, which is more effective, is not an option. Saskatchewan and Quebec are the only provinces that currently cover rTMS treatment costs.
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