The 2019 CTMS Conference in Vancouver BC was chalk-full of exciting conversations and take-away’s. Amanda Itzkoff, MD of NYC Psychiatry was excited to participate. Here are three exciting developments you may want to keep tabs on in the future:
- Combination of Ketamine & TMS as a Treatment for TRD
There have been rumblings about using ketamine and TMS in combination as a treatment for treatment-resistant depression for years. As the ketamine and TMS markets continue to grow in North America and further research is conducted, interest in this approach to treatment is growing. Case studies like this one from the Neuroscience Center in 2017 illustrate the potential of this technique and the careful consideration it has been given to-date. There was further discussion of recent
research that has shown the efficacy of transcranial magnetic stimulation, and of intravenous ketamine, as therapeutic approaches in treatment resistant depression and anxiety at this years CTMS conference.
2. Nolan William’ Lab at Stanford on Accelerated ITBS
The work coming from Dr. Nolan Williams at Stanford University lab is illuminating. In brief, this study evaluates an accelerated schedule of theta-burst stimulation for inpatients with major depressive disorder. This study intends to investigate whether modifying stimulation parameters enables typical 6-8 week long rTMS protocols to be compressed to only five days. The influence of this accelerated protocol on the length of patient stay in the hospital and the direct total cost will be investigated. In Dr. Nolam William’s studies, nearly all treatment refractory patients respond. Patients are treated in, instead of 36 days, over just 5 days, with 10 treatments per day. The active treatment is just over 8 minutes with 50 minute pauses between treatment intervals. You can read more about Dr. Nolan William’s studies on ClinicalTrials.gov. For now, TBS is off-label but studies like this one highlight the future of TMS.
3. Additional Targeting in Neuromodulation in the Future
Finally, the potential for additional targeting in neuromodulation in the future is interesting. When TMS is administered, it is to a target, like the left dorsolateral pre-frontal cortex (LDLPFC) which is a NODE in network. Inhibitory treatment at RDLPFC enhances the same treatment, and is sometimes used alone to treat depression. We are increasingly learning that brain function is related to neural networks and that activating or inhibiting one target or brain region can restore functionality to entire network. We can also potentially affect the way networks interact with one another, as well as identify different targets within the same network for additional improvement in functioning across the network. You can read more about The Pursuit of DLPFC: Non-neuronavigated Methods to Target the Left Dorsolateral Pre-frontal Cortex With Symmetric Bicephalic Transcranial Direct Current Stimulation (tDCS) on the National Institutes of Health website HERE.