PSYCHIATRY

TMS is FDA-approved and insurer acceptance is growing.

Depression mystery

U-M team seeks to figure out why magnets work for some

issue 22 | Fall 2014

A therapy for treatment-resistant depression based on magnetic fields, not medications, may offer relief to some patients. But the underlying mechanism for symptom relief from transcranial magnetic stimulation (TMS) has not yet been identified.

A new clinical trial at the U-M Depression Center and Department of Psychiatry is now recruiting volunteers to receive the standard therapy along with advanced medical imaging so that researchers can examine the response.

The study will provide up to 25 TMS treatments to patients who haven't responded to at least one antidepressant medication, preceded and followed by functional magnetic resonance imaging.
Although all volunteers will receive TMS therapy eventually, some will randomly receive a sham treatment at first, to allow research on the treatment's potential placebo effect. Those who receive the sham stimulation can go on to receive 25 active treatments after the first phase of the study is completed.

TMS therapy carries U.S. Food and Drug Administration approval, and a growing number of insurers cover it  — though many still do not. Study participants receive treatment at no cost to them.

The advanced medical imaging used in the study may give a better picture of what TMS treatment does within the brain.

The lack of clearly convincing evidence, and lack of understanding of the root of the therapy's effects, are why the new study is needed, says its principal investigator, U-M psychiatrist Stephan Taylor, M.D.

"Previous research suggests that TMS may restore balance between the executive functioning areas at the front of the brain and areas involved in emotional responses and negative thoughts," Taylor says. "We hope that by studying brain function in patients undergoing TMS, and sham TMS, we can help explain what is going on and perhaps illuminate why some patients experience remission after treatment. "

U-M is the only site in the country for the study, which is funded by the National Institutes of Health. The manufacturer of the TMS device contributed funding and the device that will allow the researchers to deliver the sham treatment, but is not involved in the study. U-M's Functional MRI Laboratory will be used for pre- and post-treatment imaging.