Depression study offers chance at innovative treatment through brain pulses

A Winnipeg psychiatrist is searching for people to take part in a research study that may include access to a groundbreaking treatment for depression.

Dr. Mandana Modirrousta, a neuropsychiatrist and researcher at St. Boniface Hospital, is looking for 64 Manitobans with "treatment-resistant depression" to take part in the study.

She is seeking anyone who has tried two different treatments, such as talk therapy and a drug, but is still suffering from symptoms of depression. 

Those who take part may have one of three treatments:

• Their current anti-depressant drug will be switched to Venlafaxine, which is sold under the brand name ​Effexor XR. It increases the concentrations of the neurotransmitters serotonin and norepinephrine in the body and the brain and is licensed for the treatment of major depressive disorder, generalized anxiety disorder, panic disorder and social phobia.
• Their current drug will have Aripiprazole, sold under the brand name Abilify, among others, added to it. The antipsychotic drug works in concert with other antidepressants.
• They will be treated with something called repetitive transcranial magnetic stimulation, or RTMS.

The latter works through neuroplasticity, or the ability of the brain to form and reorganize synaptic connections.

Theories about neuroplasticity reflect the idea that our brains aren't rigidly hardwired, as was once believed, but that they can change and be rewired.

"Basically there is a network, or different areas in our brain, that is involved in regulating our mood. When this network doesn't work properly, people become depressed," said Modirrousta, who is also an associate professor of psychiatry at the University of Manitoba.

"RTMS is a non-invasive, safe method of brain stimulation in a relatively focused area. It stimulates the brain cells which are connected to other parts of the network … and we can either increase or decrease the activity of that network.

"After this is repeated over time … the brain takes over and they don't need to give more TMS pulses. The brain does it itself."

St. Boniface Hospital is one of three Canadian sites involved in the study headed by Massachusetts General Hospital in conjunction with Harvard University.

The study will take place over four years, with each participant being treated over an eight-week period. The type of treatment a person receives will be chosen at random.

Modirrousta, who is co-ordinating the Winnipeg part of the study, is in charge of the St. Boniface Hospital RTMS clinic, which has been going since January 2012.

Typically, the treatment is done daily, maybe twice daily, for a few weeks. Depending on studies that will have been done on the patients' brains before starting, the pulses could be high frequency for just five minutes per session or lower frequency for 30 minutes or so.

Her research suggests the treatment is effective for about 65 per cent of people, who say their concentration is better, they can think clearer, and they have more energy and motivation and fewer instances of depression.

Of those, however, about half relapse six months after the RTMS treatments stop, Modirrousta said. 

"But this also means another 50 per cent still is doing well," she said, adding those who do relapse are given a "booster session as a maintenance treatment" every six months.

"If it does work for someone, it's a fantastic treatment because it does not have those systemic side-effects of medications."

Anyone who would like to participate can call Modirrousta's research assistant at 204-237-2677 or email rtms@sbgh.mb.ca.

Anyone who doesn't qualify for the study but wants to try RMTS needs to get a referral from their family doctor or their psychiatrist, Modirrousta said.

The treatment, however, is not covered by Manitoba Health. Modirrousta's team took their research evidence to the government a while back, noting it is within the Canadian guidelines for the treatment of mood disorders and is covered in other provinces, such as Quebec and Saskatchewan.

But in December 2016, Manitoba Health decided against adding it to the list of covered treatments.

Modirrousta estimates the cost to be between $5,000 and $10,000 per treatment. They have been fundraising as well as applying for private grants so that anybody who needs it can still get it.

The waiting list for treatment is about six months because her clinic, which has two machines, can only take a maximum of 12 people per month, she said.