Dr. Sara Tremblay, a scientist at The Royal’s Institute of Mental Health Research (IMHR), has been tirelessly working for the past two years to bring an rTMS clinical-research platform to The Royal, in an effort to help people living with treatment resistant depression – those who have failed to respond to one or more different antidepressant medications.
Repetitive transcranial magnetic stimulation (rTMS), is a type of neuromodulation that directly stimulates the specific brain circuit that is known to be dysfunctional in people with major depression. This is done by producing a brief and painless magnetic field that is delivered via a coil placed against the scalp.
“Across the mental health landscape, clinicians, researchers and patients are all becoming increasingly aware that there is an urgent need for new, alternative therapies for mental health disorders,” says Dr. Tremblay. “Neuromodulation offers us a whole new way of looking at mental health treatment, where we can identify malfunctioning circuits in the brain, and effectively treat them in a non-drug, non-invasive way.”
This dream of Dr. Tremblay’s became a reality in January 2020. The Royal’s new rTMS clinical-research platform is the first of its kind in the Ottawa region, and is quickly becoming a much sought-after treatment for depression. Dr. Tremblay had started enrolling research participants in the study when the COVID-19 pandemic hit. Physical distancing measures have necessitated the postponement of rTMS sessions; Dr. Tremblay and her team are looking forward to continuing this in-person aspect of their research as soon as it is safe to do so.
Because rTMS has very few side effects, it is rapidly becoming a preferred treatment. Additionally, the options are quite limited when treating young adults with depression. For example, many elderly patients are also limited in their use of antidepressant drugs because of poor kidney or liver function. rTMS as an alternative to drug interventions is useful for a wide range of people.
rTMS was approved in 2002 by Health Canada, but unfortunately only three provinces – Saskatchewan, Quebec and Yukon – have publicly funded this innovative treatment. Those who live in large urban centres with private clinics can pay out of pocket for treatment, but for many, the only other way to access rTMS is through research. Through this clinical-research platform at The Royal, Dr. Tremblay’s goal is to offer treatment to as many people as she can, while collecting research data to help better predict and refine rTMS treatment on a continuous basis.
“Research in this area is leading to a better, more personalized standard of care for patients with depression and related mental health disorders, for whom traditional treatments haven’t worked,” says Dr. Tremblay.
In her latest study, Dr. Tremblay is using a new form of rTMS called Theta-Burst Stimulation (TBS) for the treatment of depression. This new form of rTMS reduces the duration of daily treatments from 45 to 4 minutes. Her research team is trying to determine if applying this new form of rTMS to both sides of the head is more efficient than if they apply it on only one side. This study will help to determine what factors make this treatment effective and develop tools to identify individuals who are more likely to respond to treatment.
For a period of 4-6 weeks, five days a week, the study participants come to The Royal for a 20 min session in which rTMS is applied for 4 min. Although this may seem like a big time commitment, the results from rTMS have been quite positive. In fact, recent large trials have shown response rates similar to antidepressant medications; about 50% see a significant reduction in their symptoms – which includes 30% who achieve complete remission.
The ultimate goal is to eventually obtain the necessary funding to expand upon the current rTMS clinical-research platform, to offer different types of rTMS treatments to individuals with treatment-resistant depression, but also for individuals living with other mental health disorders such as post-traumatic stress disorder and schizophrenia. This rTMS Clinical Program could be fully embedded within The Royal’s offer of care, with a central research focus allowing data collection to continuously improve treatments. An rTMS Clinical Program would provide patients with a fast, free, safe and effective method to help treat chronic and treatment-resistant mental health disorders.
Click here if you are interested in learning more about Dr. Tremblay’s research in rTMS treatment.