What if the key to making treatment for depression more effective lies in something as simple as moving your body?
Researchers at The Royal are beginning to uncover how physical activity may hold the power to boost a cutting-edge therapy called repetitive transcranial magnetic stimulation (rTMS) for people who are diagnosed with treatment-resistant depression (TRD).
In the Neuromodulation Research Clinic at The Royal, most – but not all – individuals with TRD respond positively to rTMS treatment and a newer variation called Theta Burst Stimulation (TBS). rTMS directly stimulates a specific brain circuit by producing a brief, painless magnetic pulse delivered via a coil placed against the scalp. It doesn’t involve invasive surgical procedures or medication and has minimal side effects.
Dr. Sara Tremblay, a scientist at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal, and Dr. Arthur Chaves, a neuroscientist and exercise physiologist, were curious about why some individuals respond to TBS while others don’t.
Tremblay and Chaves analyzed data from 43 clients with TRD who completed TBS treatment at the clinic and found that people who were physically active before starting treatment showed a greater reduction in depressive symptoms than physically inactive participants.
As one of the authors of a resulting paper published in the Journal of Affective Disorders, Tremblay describes these findings as “remarkable.”
“We know exercise is good for the brain. We were expecting an effect, but when we saw the difference, it was almost unreal to see how much it helped,” says Tremblay.
Although the positive impact of exercise on brain health is well-documented, the team was surprised to see how much physical activity influenced treatment responsiveness. Typically, 60-70 per cent of people who undergo TBS treatment have a positive response, but when the team looked more closely at the data, they discovered that individuals who completed TBS treatment and had fitness regimes that included running, cycling, walking and gym workouts – had a greater response rate. In fact, 86 per cent of treatment recipients who exercised had lower depression scores after their TBS treatment.
Chaves says the results are exciting but there is still much to learn. Fortunately, the team now has an opportunity to take their research another step forward. As one of the recipients of this year’s University Medical Research Fund (UMRF) grant, they will be able to dig deeper into the impact of exercise on TBS treatment.
The UMRF grant competition is made possible by contributions from the members of The Royal’s Associates in Psychiatry and was established to foster novel, multi-and inter-disciplinary research at The Royal.
"Research is the key to unlocking new possibilities for people with treatment-resistant mental illness. At The Royal, we are committed to exploring innovative approaches that offer hope where traditional therapies have fallen short,” says Dr. Florence Dzierszinski, president of the IMHR and vice-president of research. “Every discovery brings us closer to more effective treatments and, ultimately, a better quality of life for our clients and their families."
The UMRF-supported phase of research will recruit individuals with treatment-resistant depression who are not physically active. In the first phase, the team will work with participants to build their individualized exercise programs before beginning TBS treatment. Participants will exercise three times a week for four weeks to “prep” the brain for treatment. In the second phase, the participants will receive TBS treatments for six weeks while still exercising three times a week.
The research will attempt to answer questions about the effects of moderate-to-vigorous aerobic exercise combined with TBS on symptoms, response, and remission rates and how exercise and TBS affect brain activity and blood flow.
In her work at the Neuromodulation Research Clinic, Tremblay has been looking for ways to make rTMS treatment more effective for people with TRD, such as using advanced brain imaging to target treatment. While these methods hold promise, there’s an urgent need for simpler, more affordable approaches that can be used in everyday settings, like exercise.
One of the challenges in this area of research, however, is that people who are diagnosed with depression often experience low motivation, fatigue, and low energy, all of which make it difficult to engage in regular physical activity. As such, the research team is exploring ways to make physical activity more manageable for individuals going through TBS treatment. One of their goals is to find practical strategies to help make exercise accessible and enjoyable, and if exercise is enjoyable, people are more likely to stick with it.
A longer-term follow-up with the study participants will reveal whether personalized fitness plans were effective and whether regular exercise can sustain the effects of the rTMS treatment.
“If exercise is the key, it could make a difference in people's trajectory,” reflects Tremblay. “Maybe it also sustains the effect of rTMS. We think that if it helps the brain respond to treatment, maybe it keeps the effect longer. That's one of the other challenges ahead of us – now that we know rTMS works, how can we make it work for longer so that people don't have to come back?”
For more information about the Neuromodulation Research Clinic at The Royal, click here.