Transcranial magnetic brain stimulation is promising in treating seasonal depression.

Repetitive transcranial magnetic stimulation, a non-invasive brain stimulation technique, may be an effective and well-tolerated treatment for major depressive disorder with seasonal patterns, according to new research. This finding holds significant promise for expanding treatment options for people suffering from seasonal depression, especially in areas with limited sunlight during the winter months. The study was published in psychiatric research,

Major depressive disorder, a common mental health condition, affects millions of people around the world. In particular, a significant subgroup of depressed individuals experience a seasonal pattern, often worsening during the shorter, darker days of winter. This study was motivated by the need to understand whether rTMS, an established treatment for MDD, is equally effective for people experiencing seasonal changes in their depressive symptoms.

Repetitive transcranial magnetic stimulation, or rTMS, is a form of brain stimulation therapy used to treat depression and other disorders. It involves placing a magnetic coil near the scalp, where it sends magnetic pulses to stimulate specific areas of the brain. This non-invasive method is increasingly being recognized for its ability to reduce symptoms of depression, especially in cases where traditional treatments such as medication have not been effective.

“Like most studies in science, this arose from an observation that we decided to study systematically,” said study author Peter Giacobbe, an associate scientist at Sunnybrook Health Sciences Center in Toronto. “Living in Canada, the days appear much shorter during the months of November to March and the number of hours of sunlight is greatly reduced.”

“Like other countries with northern climates, rates of seasonal affective disorder are higher in Canada during these months than in countries closer to the equator. In countries in extreme southern latitudes the seasonal pattern will be reversed, with shorter days (and greater negative effects on mood) during the months of May to August.

Giacobbe said, “Many of our patients will report a decline in their mood in the late autumn and winter months, which may be noticeable in their sleep duration, social activity levels, mood or emotional well-being, weight, appetite and energy levels. Caused by seasonal changes.” “Many of our patients felt that rTMS treatments were helpful in reducing or preventing seasonal declines in their mood, although rTMS was not identified as an effective treatment for seasonal affective disorder.”

“Additionally, we noted that during these months there was an increase in requests for additional ‘booster’ rTMS treatments among our patients who had previously been successfully treated with rTMS at the beginning of the year. As a result, we wanted to study whether in fact rTMS – which is an approved treatment for major depressive disorder but has not yet been studied in seasonal affective disorder – would be an effective option for people with seasonal depression.

“We were pleased to find that this was indeed the case, expanding the number of viable treatment options for this group of people and suggest that it would be important for physicians to listen to the ‘signals’ provided by our patients and systematically follow up. And it is important to study them,” Giacobbe said.

The researchers conducted a retrospective analysis of 127 patients who received their first rTMS treatment at the Harquail Center. These patients, aged 16 years and older, were diagnosed with major depressive disorder. To assess the severity of their depression and the presence of seasonal patterns, two major instruments were used: the Hamilton Depression Rating Scale (HAMD-17) and the Individual Inventory for Depression and Seasonal Affective Disorder (PIDS).

About 46% of participants were identified as having a seasonal pattern in their depression. This high prevalence highlights the importance of finding effective treatments for this subgroup.

Patients underwent high-frequency rTMS targeting the left dorsolateral prefrontal cortex, an area of ​​the brain associated with mood regulation, for a period of 4 to 6 weeks. “rTMS is a treatment that is usually given 5 days a week for 4 to 6 weeks, for a total of 20-30 sessions. Each treatment session lasts between 3 and 20 minutes depending on the protocol selected,” Giacobbe explained.

The effectiveness of the treatment was evaluated through improvements in their HAMD-17 scores as well as self-reported changes in depression symptoms using the Quick Inventory of Depressive Symptomatology (QIDS).

The researchers found that rTMS significantly improved depression symptoms, regardless of whether patients exhibited seasonal patterns. Notably, about 32% of patients achieved remission, and 55% responded positively to the treatment, seeing a 50% or more reduction in their HAMD-17 scores.

Interestingly, the study also found that higher scores on the Individual Inventory for Depression and Seasonal Affective Disorder were associated with greater improvement in depression symptoms when rTMS treatment began between September and February. Furthermore, research indicated that typical and atypical neurovegetative symptoms, such as changes in sleep patterns and appetite, improved equally during treatment, regardless of the season.

“In terms of evidence-based options for treating seasonal depression, both light therapy and SSRI medications have proven effective, but many people who seek treatment in our clinic with brain stimulation techniques such as rTMS have not received either of these treatments. Has not replied. Or looking for options to help them,” Giacobbe told PsyPost. “This study is the first of its kind to suggest that brain stimulation techniques such as rTMS may be an effective and well-tolerated treatment option for people with seasonal depression.”

“The results of this study potentially expand the number of treatment options available for this group, especially in those who cannot tolerate and/or do not respond to light therapy or SSRI medication. Given the time-limited nature of rTMS treatment, it provides a targeted and time-limited therapeutic approach to effectively treat seasonal depression during people’s greatest need in the autumn and winter months. It also provides justification for offering booster TMS to those who have already responded to TMS in order to reduce or prevent the risk of relapse during seasonal periods of exposure.

Despite these promising findings, the study has limitations. Notably, it was a retrospective analysis, meaning it looked at existing data rather than setting up a new experimental design. This approach, while valuable, does not offer the control and randomization of a prospective study. Additionally, the study lacked a sham control group, which is often used to measure placebo effects.

“Given that this was not a randomized controlled trial, we still did not know what the ‘active ingredients’ were in the improvements we noted,” Giacobbe explained. “It is not clear to what extent non-specific aspects of coming for treatment were playing a role in the positive outcomes, i.e. the behavioral activation of leaving one’s home and coming to the hospital every day for 4 to 6 weeks and/or the treatment sessions. Brief social interaction with the nurse rTMS operator during. We also don’t know whether the combination of light therapy plus rTMS is better than either treatment alone. This is something we hope to study in the future.”

This study serves as an important step for further research. Prospective, controlled trials may offer more definitive findings regarding the effectiveness of rTMS in preventing the onset of seasonal depression and its long-term benefits.

Study, “Seasonal Patterns and Results of Depression from Repetitive Transcranial Magnetic Stimulation”, Enoch Ng, Sean M. Nestor, Jennifer S. It was written by Rabin, Clement Hamani, Nir Lipsman and Peter Giacobbe.

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