Clients with refractory and difficult-to-treat psychiatric disorders.
Please have your doctor complete a CAMH referral form and fax it to Access CAMH, CAMH’s centralized intake. Please indicate "brain intervention" or "difficult-to-treat depression" on the referral form. If you have any questions about the referral or intake process, please call Access CAMH.
Please refer to the Temerty Centre's web page.
The Temerty Centre for Therapeutic Brain Intervention uses electroconvulsive therapy (ECT) , magnetic seizure therapy (MST), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). The service offers consultation on clients with refractory and difficult-to-treat psychiatric disorders.
The service has a clinical research focus. The novel treatments (rTMS, MST and tDCS) that are available are primarily offered in the context of participation in ongoing clinical trials. Clients who are interested in participating in one of the clinical trials will meet with a research analyst following the psychiatric consultation for more detailed description of the available studies. They will undergo more detailed screening to ensure eligibility.
Repetitive transcranial magnetic stimulation (rTMS) involves a series of short magnetic pulses directed to the brain to stimulate nerve cells. Since 1985, research has been conducted with rTMS to understand and treat a number of neurological conditions (e.g., migraines, Parkinson’s disease, tinnitus) and psychiatric conditions (e.g., depression). Most recently, the use of rTMS as a treatment option for major depressive disorder has established evidence as an efficacious treatment.
The magnetic energy released from the rTMS device passes through the skull easily. The energy is directed to access brain structures that are thought to control mood (limbic system). Stimulation is limited to a small area and has little effect on the surrounding tissue.
Electroconvulsive therapy (ECT), also referred to as “shock therapy,” is perhaps the most controversial and misunderstood of psychiatric treatments, due in part to sensationalized and misleading depictions of the treatment in the popular media. In fact, ECT is a highly effective and safe treatment for both the depressive and manic phases of bipolar disorder, and it is sometimes used as a long-term maintenance treatment to prevent recurrence of illness after recovery.
ECT does not resemble the shock therapy portrayed in films such as One Flew over the Cuckoo’s Nest. Now patients are given muscle relaxants and a general anesthetic before a mild electrical current is administered to one or both sides of the brain. There is minimal visible movement in the patient during the procedure. Usually the treatments are administered three times a week over three to four weeks, for a total of eight to 12 treatments. For longer-term maintenance treatment, the treatments may be spread out—for example, once a month—and continued for as long as the patient and doctor feel is appropriate. ECT is usually given to hospitalized inpatients, but outpatients can receive ECT as well.
ECT is the most effective and possibly the fastest-acting treatment for severe depression. It's particularly helpful for people who are highly agitated or suicidal, or those with psychotic or catatonic symptoms. Some people receive ECT early in their episode of illness because of the urgency of their situation or their particular symptoms, while for other patients ECT may be used only after various medications have failed. ECT works well for severe mania as well.
While ECT is highly effective at ending an episode of depression or mania, the benefits may not last more than a few weeks or months following treatment. After a course of ECT, patients usually start or continue treatment with mood stabilizers and/or other medication. Maintenance ECT may be used when medications have not prevented a recurrence of the illness or for patients who cannot tolerate the side-effects of medication.
Magnetic seizure therapy (MST) involves the induction of a seizure by applying magnetic stimulation to the brain. The first MST seizure was induced in 1998. MST is being investigated as an alternative to ECT in order to find a beneficial treatment for depression, psychosis and obsessive-compulsive disorder with fewer cognitive side effects.
In MST, high intensity magnetic field pulses are delivered through a magnetic coil. Rapidly alternating strong magnetic field pulses pass freely into a focused area of the brain and create a seizure. Stimulation is limited to a focused area in the brain and has minimal effect on the surrounding brain tissue. This results in minimal cognitive side effects. MST produces an increase in cerebral blood flow to the regions of the brain responsible for depressive symptoms.
MST is only provided as part of a research study. You must meet the study criteria in order to receive MST. The chance to be part of the clinical trial and receive MST is offered to those experiencing symptoms of depression, schizophrenia or obsessive-compulsive disorder.
An anesthesiologist will assess if you are medically stable to have anesthesia. The number of treatment sessions will vary depending upon your response and the study you are involved in. In general, a treatment course can be as long as 15 to 24 treatments. Common effects after MST are headache, dizziness, nausea or vomiting, muscle aches and fatigue. These may be caused by the anesthetic, the MST or not having anything to eat or drink for a long time.
Transcranial Direct Current Stimulation (tDCS) involves the delivery of a low intensity electric field to the brain through a small, portable battery-operated device. Approved by Health Canada, tDCS has been shown to have antidepressant effects and, when administered simultaneously with a cognitive task, can enhance the performance of a learned activity. A non-invasive, cost-effective and well-tolerated therapy, tDCS uses low amplitude direct currents to induce changes in the brain’s excitability and can be self-administered in a home setting. Recently, tDCS has been investigated as a continuation treatment for major depressive disorder and has been shown to prolong the period of remission after an acute course of treatment.
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