Theta-burst TMS

Transcranial magnetic stimulation, more commonly known as TMS, is one of the safest, most effective therapies for those suffering from treatment-resistant depression. Since its FDA-approval in 2008, TMS has become a prevalent and respected therapy among mental healthcare providers and it’s easy to see why. On average, 50 to 60% of patients who receive TMS therapy demonstrate a substantial reduction in depression-related symptoms (Stern, 2018). What’s more, by locally stimulating key areas of the brain, TMS avoids the often unpleasant side effects that accompany many medications, which diffuse throughout the bloodstream. Despite achieving this admirable combination of high efficacy and reduced side effects, TMS therapy has one notable drawback: time.

The average TMS session lasts about 37 minutes and this time might extend to an hour if a second protocol is included. With a typical treatment period of 4 to 6 weeks and 5 treatments-per-week, the time adds up quickly. However, a new protocol called theta-burst has the potential to make this time burden a thing of the past.

Theta-burst utilizes the same mechanism as traditional TMS protocols: an MRI-strength magnet positioned over the scalp, which induces a small electrical current in the brain. At certain frequencies this stimulation is able to induce or inhibit activity in a given brain area. Then, after a series of consistent treatments, TMS can change the baseline activity of that brain region; overactive areas can be calmed and underactive areas can be given the boost they need to function properly. However, while the traditional protocols deliver regular or clustered magnetic pulses over a 20-50 minute period, theta-burst delivers much higher frequency pulses, reducing treatment time to just over 3 minutes.

Now you might be thinking, “less time out of my day for treatment sounds great, but is theta-burst as effective as the traditional protocols?” In 2018, a group of physicians and researchers funded by the Canadian Institutes of Health Research came together to answer just this question. The study was comprised of nearly 400 participants all diagnosed with treatment-resistant depression. This population was split into two groups: one would receive the standard TMS protocol and one would receive theta-burst. By the end of the treatments the researchers observed no difference in outcome between groups; 50% of patients receiving theta-burst treatment showed a significant reduction clinical depression measures and 32% achieved remission. For comparison, those patients on their second or third medication trial have a remission rate of around 13% (Blumberger et al., 2018).

So we know theta-burst works, but the protocol is especially exciting for what it’s efficiency means for patients and their providers. For those receiving TMS therapy, the reduced treatment duration can mean an easier time fitting daily sessions into your already busy life. You can pop by the clinic during your lunch break or make it a pit stop on your commute home from work. Shorter sessions also open up the possibility of multiple sessions per day, which may cut a 1-2 month process down to a couple weeks. For providers, 3-minute treatments are an opportunity to take on more patients seeking TMS and potentially decrease costs of operation.

TMS already revolutionized the treatment of depression and theta-burst promises a future in which TMS is more accessible and efficient, making it possible for more people to beat depression, faster.

 

References:

Blumberger, Daniel M, et al. “Effectiveness of Theta Burst versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Patients with Depression (THREE-D): a Randomised Non-Inferiority Trial.” The Lancet, vol. 391, no. 10131, 28 Apr. 2018, pp. 1683–1692., doi:https://doi.org/10.1016/S0140-6736(18)30295-2.

Stern, Adam P. “Transcranial Magnetic Stimulation (TMS): Hope for Stubborn Depression.” Harvard Health Publishing, Harvard Medical School, 23 Feb. 2018, www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335 .

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