Healthcare (Commonwealth Union) – Approximately 5 percent of adults are believed to experience depression. While various treatments, including antidepressants and cognitive behavioral therapy (or “talking therapy”), are available, they prove ineffective for nearly one-third of those affected.
Depression often involves reduced activity in some brain areas, such as the dorsolateral prefrontal cortex, and heightened activity in others, like the orbitofrontal cortex (OFC).
In the UK, NICE, and in the US, the FDA, have approved repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (an area toward the upper front of the brain) as a treatment for depression. Studies have shown that rTMS can significantly improve symptoms after 20 sessions, typically spread across 20-30 days. However, this extended schedule may not be suitable for everyone, especially for those in acute distress or facing suicidal thoughts.
In a study published in Psychological Medicine, researchers from Cambridge, UK, and Guiyang, China, explored the effectiveness of an accelerated form of rTMS. This method still involves 20 sessions but administers four daily sessions over five consecutive days.
The researchers also put to the test a “dual” method, applying a magnetic field therapy to the right OFC (located beneath the dorsolateral prefrontal cortex) alongside the left prefrontal treatment.
Seventy-five patients were enrolled in the trial from the Second People’s Hospital of Guizhou Province, China. Their depression levels were assessed using the Hamilton Rating Scale for the Depression treatment.
Participants were randomly divided into three groups: a “dual” group, which received TMS first on the right and then on the left side of the brain; a “single” group, which received sham TMS on the right followed by active TMS on the left; and a control group, which received a sham treatment on both sides. Each session lasted a total of 22 minutes.
The dual treatment group showed a significant improvement in scores immediately after the final session, outperforming the other two groups. When researchers analyzed clinically meaningful responses — defined as a score reduction of at least 50% — they found that nearly half (48%) of patients in the dual treatment group experienced this level of improvement. In contrast, less than one in five (18%) of those in the single treatment group and under one in 20 (4%) in the control group achieved similar results.
Four weeks after treatment, about 61% of participants in the dual group and 59% in the single treatment group maintained clinically meaningful responses, compared to just over 22% in the control group.
Professor Valerie Voon from the Department of Psychiatry at the University of Cambridge, who is the lead the UK component of the research, says “Our accelerated approach means we can do all of the sessions in just five days, rapidly reducing an individual’s symptoms of depression. This means it could be particularly useful in severe cases of depression, including when someone is experiencing suicidal thoughts. It may also help people be discharged from hospital more rapidly or even avoid admission in the first place.
“The treatment works faster because, by targeting two areas of the brain implicated in depression, we’re effectively correcting imbalances in two import processes, getting brain regions ‘talking’ to each other correctly.”
Researchers of the study pointed out that the treatment was most effective in patients who, at the trial’s outset, showed stronger connectivity between the OFC (orbitofrontal cortex) and the thalamus, a central brain region involved in regulating consciousness, sleep, and alertness. The OFC plays a key role in decision-making, especially in choosing rewards and avoiding punishments. Its heightened activity in depression, particularly linked to its anti-reward or punishment function, may explain why individuals with depression often have negative expectations and engage in repetitive negative thoughts.
Dr. Yanping Shu from the Guizhou Mental Health Centre in Guiyang, China, indicated that the new treatment has shown a stronger and faster improvement in response rates for patients with major depressive disorder. Dr. Shu further indicated that it marks a major advance in treatment outcomes, facilitating quicker hospital discharges for those with treatment-resistant depression, further stating that they are optimistic that it will open up new opportunities in mental health care.
