Psychiatrists offer five-day accelerated intervention for treatment-resistant depression
New non-invasive treatment targets neural networks linked to depression
By EMILY LOMBARDE — science@theaggie.org
UC Davis Health’s Advanced Psychiatric Therapeutics (APT) clinic recently introduced a new method to combat treatment-resistant depression (TRD). While conventional interventions for TRD include prescription esketamine, transcranial magnetic stimulation, electroconvulsive therapy and deep brain stimulation, the clinic has recently added the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) program.
The DSM-5, the clinical guideline for psychiatric disorders, characterizes major depressive disorder by the presence of five or more symptoms such as apathy, anhedonia or disturbances in sleep during a two-week period that causes a major change in behavior.
Vice Chair of Hospital Psychiatric Services and Alan Stoudemire Professor of Psychosomatic Medicine James Alan Bourgeois explained the key difference between major depressive disorder and TRD.
“Treatment-resistant depression refers to somebody who is diagnosed with a depression episode…but then fails to respond to appropriate treatment,” Dr. Bourgeois said.
Bourgeois highlighted the specific patient criteria that meets TRD.
“What it usually means is [that] someone [has] had two separate episodes of depression, then they have a trial of one medication for six weeks to eight weeks at full dose without improvement, then they're switched to a second medication plan. So now they've failed treatment twice, if you will,” Bourgeois said.
SAINT uses a functional magnetic resonance imaging (fMRI) scan to assess brain structure and communication, identifying localized treatment areas for individual patients based on neuronal connectivity. Physicians then use targeted TMS to target specific abnormal brain connections that are related to depression.
UC Davis Associate Physician Dr. Katharine Marder explained the key benefits of SAINT in comparison to conventional treatment programs.
“[SAINT is] also very precise because the MRI is being used to guide the treatment delivery with a precision of about a millimeter or less,” Dr. Marder said.
“The other key difference is the schedule… instead of doing one treatment session a day for five days per week for six weeks, patients come into [the] clinic and do 10 sessions a day for just five days in a row,” Marder said.
The introduction of treatments such as SAINT raises new questions regarding investigating disorders that can be treated with the same technology. Professor and Vice Chair of Research, Robert H. Putnam Endowed Chair in Bipolar Research and Treatment, Dr. Manpreet Kaur Singh mentioned how SAINT could be useful in treating substance abuse disorders.
“We're doing some very innovative studies to develop evidence-based treatments, not just for difficult-to-treat depression and OCD, but also substance use disorders,” Singh said.
“Cannabis use disorder is a huge problem in adolescents and young adults with the legalization and popularity of vaping. There are no FDA-approved treatments for cannabis use disorder in youth and young adults. So, we're actually putting some research grants in this month to be able to apply targeted TMS to those affected by problematic cannabis use.”
Singh credited Resident Physician Dr. Se Ri (Sally) Bae, with demonstrating this possibility through a study involving people ages 15 to 25 with severe depression and suicidal thinking, where the treatment presented feasibility and a considerable reduction in depression symptoms within five days of administration.
Treatments for TRD are advancing, but Singh explains the research behind them is still in its early stages.
“We are still in the early stages of building several components of this research program, but the opportunity to connect innovative treatments with thoughtful, patient-centered research is tremendously exciting,” Singh said.
For more information about SAINT and the APT clinic, visit UC Davis Health’s Mood Disorders and Depression page.
Written by: Emily Lombarde — science@theaggie.org